Basic Information
| Provider Information | |||||||||
| NPI: | 1902366768 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MCCLURKIN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Mailing Information | |||||||||
| Address1: | YALE UNIVERSITY DEPARTMENT OF PSYCHIATRY | ||||||||
| Address2: | 300 GEORGE STREET, SUITE 901 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037852095 | ||||||||
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| Practice Location | |||||||||
| Address1: | YALE UNIVERSITY DEPARTMENT OF PSYCHIATRY | ||||||||
| Address2: | 300 GEORGE STREET, SUITE 901 | ||||||||
| City: | NEW HAVEN, | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037852095 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2019 | ||||||||
| LastUpdateDate: | 07/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 390200000X | CT | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2084P0800X | 69150 | CT | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.