Provider Demographics
NPI:1881092898
Name:CLAYTON, DWANNE SURELLE (MSW, LCSW, CDP)
Entity type:Individual
Prefix:MS
First Name:DWANNE
Middle Name:SURELLE
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:MSW, LCSW, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 LIDO CIR APT 301
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-1838
Mailing Address - Country:US
Mailing Address - Phone:561-703-0509
Mailing Address - Fax:
Practice Address - Street 1:901 VILLAGE BLVD STE 702
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1947
Practice Address - Country:US
Practice Address - Phone:561-990-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW208231041C0700X
FLISW6205101YM0800X
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker