Provider Demographics
NPI:1366111320
Name:MCCLENTON, OLIVIA S (MA)
Entity type:Individual
Prefix:MISS
First Name:OLIVIA
Middle Name:S
Last Name:MCCLENTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 N SMITH ST
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1707
Mailing Address - Country:US
Mailing Address - Phone:732-910-1868
Mailing Address - Fax:
Practice Address - Street 1:121 JOHNSON ROAD
Practice Address - Street 2:STE. 5
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-373-5370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health