Provider Demographics
NPI:1245636422
Name:MCCLUNG, JEANNE CORDELIA (MSW)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:CORDELIA
Last Name:MCCLUNG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:CORDELIA
Other - Last Name:REISINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:671 EXCHANGE STREET
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456
Mailing Address - Country:US
Mailing Address - Phone:315-789-2613
Mailing Address - Fax:315-789-2524
Practice Address - Street 1:671 EXCHANGE STREET
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456
Practice Address - Country:US
Practice Address - Phone:315-789-2613
Practice Address - Fax:315-789-2524
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730472471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical