Provider Demographics
NPI:1841449139
Name:CLONAN-PROCKTER, TARA MARIE (LCSW, ACSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MARIE
Last Name:CLONAN-PROCKTER
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1983 ROUTE 52
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-3513
Mailing Address - Country:US
Mailing Address - Phone:845-264-2511
Mailing Address - Fax:845-896-2215
Practice Address - Street 1:1983 ROUTE 52
Practice Address - Street 2:SUITE 6
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-3513
Practice Address - Country:US
Practice Address - Phone:845-264-2511
Practice Address - Fax:845-896-2215
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR069561-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical