Provider Demographics
NPI:1972370104
Name:CLANCY, MAIRA (MSW, ASW)
Entity Type:Individual
Prefix:
First Name:MAIRA
Middle Name:
Last Name:CLANCY
Suffix:
Gender:F
Credentials:MSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 7TH ST # 23103
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94615-0002
Mailing Address - Country:US
Mailing Address - Phone:610-955-6320
Mailing Address - Fax:
Practice Address - Street 1:1181 16TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-2842
Practice Address - Country:US
Practice Address - Phone:610-955-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1166881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAASW116688OtherBOARD OF BEHAVIORAL SCIENCES