Provider Demographics
NPI:1851664379
Name:CLIFFORD, MICHAEL DEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEAN
Last Name:CLIFFORD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 BROADWAY STE 1501
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4715
Mailing Address - Country:US
Mailing Address - Phone:212-982-5217
Mailing Address - Fax:
Practice Address - Street 1:853 BROADWAY
Practice Address - Street 2:SUITE 1501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-982-5217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0328581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical