Provider Demographics
NPI:1770779621
Name:MCCLELLAN, ROBERT WILLIAM (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:ROBERT
Middle Name:WILLIAM
Last Name:MCCLELLAN
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 12TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-3116
Mailing Address - Country:US
Mailing Address - Phone:631-225-1738
Mailing Address - Fax:
Practice Address - Street 1:817 12TH ST
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-3116
Practice Address - Country:US
Practice Address - Phone:631-225-1738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0692861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical