Provider Demographics
NPI:1780722207
Name:CLAVELLE, PAUL ROBERT (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROBERT
Last Name:CLAVELLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6182 CAMPFIRE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4050
Mailing Address - Country:US
Mailing Address - Phone:410-992-5289
Mailing Address - Fax:410-712-4216
Practice Address - Street 1:7272 PARK CIRCLE DR
Practice Address - Street 2:SUITE 170
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1303
Practice Address - Country:US
Practice Address - Phone:410-712-4444
Practice Address - Fax:410-712-4216
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD950103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical