Provider Demographics
NPI:1316333602
Name:RECLOSADO-BACLAY, CLAIRE MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:MARIE
Last Name:RECLOSADO-BACLAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 ROBLES WAY # 292
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8039
Mailing Address - Country:US
Mailing Address - Phone:510-255-1278
Mailing Address - Fax:
Practice Address - Street 1:701 SOUTHAMPTON RD STE 208
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2076
Practice Address - Country:US
Practice Address - Phone:510-255-1278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 103TE1100X
CAPSY31428103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports