Provider Demographics
NPI:1972840817
Name:MCCLURG ZINKIEVICH, CHERYL ELIZABETH (LCSW-R, CASAC)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ELIZABETH
Last Name:MCCLURG ZINKIEVICH
Suffix:
Gender:F
Credentials:LCSW-R, CASAC
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ELIZABETH
Other - Last Name:MCCLURG ZINKIEVICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6463 DODSON RD
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:NY
Mailing Address - Zip Code:14591-9527
Mailing Address - Country:US
Mailing Address - Phone:585-356-7598
Mailing Address - Fax:
Practice Address - Street 1:6463 DODSON RD
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:NY
Practice Address - Zip Code:14591-9527
Practice Address - Country:US
Practice Address - Phone:585-356-7598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0785901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical