Provider Demographics
NPI:1124846878
Name:MCCLENAN, PAULETTA (LCSW-R)
Entity type:Individual
Prefix:
First Name:PAULETTA
Middle Name:
Last Name:MCCLENAN
Suffix:
Gender:F
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:PO BOX 83519
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013
Mailing Address - Country:US
Mailing Address - Phone:516-286-1206
Mailing Address - Fax:800-480-8345
Practice Address - Street 1:405 RXR PLAZA
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11556
Practice Address - Country:US
Practice Address - Phone:516-286-1206
Practice Address - Fax:800-480-8345
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069332104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker