Healthcare Provider Details

I. General information

NPI: 1780879205
Provider Name (Legal Business Name): NJERI CLAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W PRATT ST
BALTIMORE MD
21201-1023
US

IV. Provider business mailing address

PO BOX 64515
BALTIMORE MD
21264-4515
US

V. Phone/Fax

Practice location:
  • Phone: 717-428-0552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberG11316
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: