Provider Demographics
NPI:1649970476
Name:CLEMENTS, MISTY (LCSW)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ROSELAND RD
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-8208
Mailing Address - Country:US
Mailing Address - Phone:717-612-8374
Mailing Address - Fax:
Practice Address - Street 1:400 ROSELAND RD
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-8208
Practice Address - Country:US
Practice Address - Phone:717-612-8374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0233981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical