Provider Demographics
NPI:1861871642
Name:MCCLELLAND, MATTHEW ALBERT (LISW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALBERT
Last Name:MCCLELLAND
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4822 MARKET ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2148
Mailing Address - Country:US
Mailing Address - Phone:330-544-8005
Mailing Address - Fax:330-783-3274
Practice Address - Street 1:4822 MARKET ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-2148
Practice Address - Country:US
Practice Address - Phone:330-544-8005
Practice Address - Fax:330-783-3274
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI1303247104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker