Provider Demographics
NPI:1194526608
Name:MCCLELLAN, ALICIA MARRIETTE
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MARRIETTE
Last Name:MCCLELLAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3706
Mailing Address - Country:US
Mailing Address - Phone:929-234-1697
Mailing Address - Fax:
Practice Address - Street 1:495 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3706
Practice Address - Country:US
Practice Address - Phone:929-234-1697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator