Provider Demographics
NPI:1245437417
Name:MCCLOUD, RUSSELL BENSON (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:BENSON
Last Name:MCCLOUD
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:MR
Other - First Name:RUSSELL
Other - Middle Name:BENSON
Other - Last Name:MCCLOUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:20204 LAKERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-8421
Mailing Address - Country:US
Mailing Address - Phone:951-776-9184
Mailing Address - Fax:
Practice Address - Street 1:5225 CANYON CREST DR
Practice Address - Street 2:BLDG. 400, SUITE 411
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6301
Practice Address - Country:US
Practice Address - Phone:951-248-4042
Practice Address - Fax:951-248-4049
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 104851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical