MEDICARE: MRS. MELINDA E CLEMENS MCCLOUD 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	096870	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720253024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELINDA E CLEMENS MCCLOUD LCSW

Provider Business Mailing Address
First Line	:	968 ABERDEEN RD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-7728
Country	:	US
Telephone Number	:	516-659-0960
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 JERICHO TPKE STE 103
Second Line	:
City	:	JERICHO
State	:	NY
Zip	:	11753-1317
Country	:	US
Telephone Number	:	631-245-7505
Fax Number	:

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

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	02/25/2024

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