Healthcare Provider Details

I. General information

NPI: 1811205677
Provider Name (Legal Business Name): DARLENE LILLIAN MARCHAND-CLIFFORD LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 MONROE ST
SAINT JOHNSVILLE NY
13452-1125
US

IV. Provider business mailing address

61 MONROE STREET
ST. JOHNSVILLE NY
13452-1125
US

V. Phone/Fax

Practice location:
  • Phone: 518-568-7023
  • Fax: 518-568-3016
Mailing address:
  • Phone: 518-568-7023
  • Fax: 518-568-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR046114-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberR046114-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: