Provider Demographics
NPI:1538420617
Name:CLAYTON, JOVANNA M
Entity type:Individual
Prefix:MRS
First Name:JOVANNA
Middle Name:M
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 ROUTE 207 APT 2
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916-2709
Mailing Address - Country:US
Mailing Address - Phone:845-248-7963
Mailing Address - Fax:
Practice Address - Street 1:2833 ROUTE 207 APT 2
Practice Address - Street 2:
Practice Address - City:CAMPBELL HALL
Practice Address - State:NY
Practice Address - Zip Code:10916-2709
Practice Address - Country:US
Practice Address - Phone:845-248-7963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator