Healthcare Provider Details

I. General information

NPI: 1437503786
Provider Name (Legal Business Name): CHARRISE MCCLELLAN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 2ND AVE
BROOKLYN NY
11215-2711
US

IV. Provider business mailing address

15 2ND AVE FL 3
BROOKLYN NY
11215-2711
US

V. Phone/Fax

Practice location:
  • Phone: 212-966-9537
  • Fax:
Mailing address:
  • Phone: 718-514-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number661997
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number404324
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: