Provider Demographics
NPI:1942693742
Name:MCCLEAN, KELLY DAMARIS (CRC, LMHC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:DAMARIS
Last Name:MCCLEAN
Suffix:
Gender:F
Credentials:CRC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4257
Mailing Address - Country:US
Mailing Address - Phone:516-242-1228
Mailing Address - Fax:
Practice Address - Street 1:1424 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4257
Practice Address - Country:US
Practice Address - Phone:516-242-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health