Provider Demographics
NPI:1386450567
Name:CLEMICK, MEGAN BRIDGET (LSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:BRIDGET
Last Name:CLEMICK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 GARRISON RD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08343-4511
Mailing Address - Country:US
Mailing Address - Phone:908-907-2954
Mailing Address - Fax:
Practice Address - Street 1:24 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-2140
Practice Address - Country:US
Practice Address - Phone:732-367-2390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05987500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty