Provider Demographics
NPI:1801019856
Name:CLINTON, ROGER LEONARD I (LMSW)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:LEONARD
Last Name:CLINTON
Suffix:I
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2711
Mailing Address - Country:US
Mailing Address - Phone:718-613-7401
Mailing Address - Fax:718-613-7434
Practice Address - Street 1:1275 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2711
Practice Address - Country:US
Practice Address - Phone:718-613-7401
Practice Address - Fax:718-613-7434
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0343071104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker