=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427029065
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAULETTA MCCLENAN LCSW PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2006
-----------------------------------------------------
Last Update Date | 10/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 HEMPSTEAD AVE STE I
-----------------------------------------------------
City | LYNBROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-507-0536
-----------------------------------------------------
Fax | 866-718-7573
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 HEMPSTEAD AVE STE I
-----------------------------------------------------
City | LYNBROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-507-0536
-----------------------------------------------------
Fax | 866-718-7573
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PAULETTA MCCLENAN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 516-507-0536
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0693321
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------