Healthcare Provider Details

I. General information

NPI: 1306881743
Provider Name (Legal Business Name): PAUL ANTHONY CLEMENTS L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 W POMFRET ST
CARLISLE PA
17013-3217
US

IV. Provider business mailing address

1017 SHANNON LN
CARLISLE PA
17013-1782
US

V. Phone/Fax

Practice location:
  • Phone: 717-258-0214
  • Fax: 717-258-3158
Mailing address:
  • Phone: 717-254-1976
  • Fax: 717-258-3158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW-015096
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier50054663
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAPITAL BLUE CROSS
# 2
Identifier1782446
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPA BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: