MEDICARE: MS. CLETA JEANNETTE MCLEOD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC00670900	NJ

General Provider Information

NPI Number	:	1003982612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CLETA JEANNETTE MCLEOD LCSW

Provider Business Mailing Address
First Line	:	82 HIGH ST APT 2J
Second Line	:
City	:	ORANGE
State	:	NJ
Zip	:	07050-1608
Country	:	US
Telephone Number	:	974-674-4688
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 PARK AVE
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07017-3849
Country	:	US
Telephone Number	:	973-678-7575
Fax Number	:	973-678-2384

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/08/2007

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