Provider Demographics
NPI:1992896138
Name:WHITE, CLAY NELSON (LICSW)
Entity type:Individual
Prefix:MR
First Name:CLAY
Middle Name:NELSON
Last Name:WHITE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
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Mailing Address - Street 1:111 PERKINS ST
Mailing Address - Street 2:#288
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4313
Mailing Address - Country:US
Mailing Address - Phone:617-983-9811
Mailing Address - Fax:617-267-3667
Practice Address - Street 1:1371 BEACON ST
Practice Address - Street 2:SUITE 304
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4905
Practice Address - Country:US
Practice Address - Phone:617-983-9811
Practice Address - Fax:617-267-3667
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA10202691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1854160Medicaid
MA1854160Medicaid