Provider Demographics
NPI:1740078252
Name:MCCLINTON, OMAR P
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:P
Last Name:MCCLINTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 WORTH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13209-2161
Mailing Address - Country:US
Mailing Address - Phone:680-302-7308
Mailing Address - Fax:
Practice Address - Street 1:210 WOLF ST STE 2
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-1029
Practice Address - Country:US
Practice Address - Phone:680-302-7308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health