Provider Demographics
NPI:1306881743
Name:CLEMENTS, PAUL ANTHONY (LCSW)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTHONY
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 SHANNON LN
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-1782
Mailing Address - Country:US
Mailing Address - Phone:717-254-1976
Mailing Address - Fax:717-258-3158
Practice Address - Street 1:47 W POMFRET ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3217
Practice Address - Country:US
Practice Address - Phone:717-258-0214
Practice Address - Fax:717-258-3158
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW-0150961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50054663OtherCAPITAL BLUE CROSS
PA1782446OtherPA BLUE SHIELD
PA1782446OtherPA BLUE SHIELD