Healthcare Provider Details

I. General information

NPI: 1760271068
Provider Name (Legal Business Name): CLAIRE VAN OGTROP PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 E FAIRMOUNT AVE
STATE COLLEGE PA
16801-5315
US

IV. Provider business mailing address

141 E FAIRMOUNT AVE
STATE COLLEGE PA
16801-5315
US

V. Phone/Fax

Practice location:
  • Phone: 814-234-3464
  • Fax: 814-308-8059
Mailing address:
  • Phone: 814-234-3464
  • Fax: 814-308-8059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. CLAIRE VAN OGTROP
Title or Position: OWNER
Credential: LCSW
Phone: 814-470-9437