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General NPI Number Information
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NPI Number | 1467520668
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Entity Type | Individual
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Provider Name | GLEN ALVIN MCCLINTOCK LCSW
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Gender | Male
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 215 NE CERRITOS DR
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City | PALM SPRINGS
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State | CA
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Zip | 92262-6530
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Country | US
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Telephone | 415-954-2022
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Fax |
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Provider Business Mailing Address
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Address Line | 1655 MISSION ST UNIT 1031
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City | SAN FRANCISCO
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State | CA
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Zip | 94103-6404
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Country | US
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Telephone | 415-954-2022
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 18890
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License Number State | CA
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