Basic Information
| Provider Information | |||||||||
| NPI: | 1629125802 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIDDLETON CLAY | ||||||||
| FirstName: | ALTAMEASE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9201 212TH ST | ||||||||
| Address2: | |||||||||
| City: | QUEENS VILLAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114281117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6462385765 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14732 JAMAICA AVE | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114354042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185268400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 09/29/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 035177-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.