MEDICARE: CASSANDRA CLINTON LICENSED SCH COUNS

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	101YP2500X	Professional Counselor	37PC01111000	NJ

General Provider Information

NPI Number	:	1386070571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA CLINTON LICENSED SCH COUNS

Provider Business Mailing Address
First Line	:	54 CLARKE AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-1011
Country	:	US
Telephone Number	:	201-892-3138
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 CLARKE AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-1011
Country	:	US
Telephone Number	:	201-892-3138
Fax Number	:

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

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	01/24/2026

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Directions to “ CASSANDRA CLINTON LICENSED SCH COUNS” Practice Location

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