Provider Demographics
NPI:1679942502
Name:LAIRD, CLINT D (LCSW & RPT)
Entity type:Individual
Prefix:MR
First Name:CLINT
Middle Name:D
Last Name:LAIRD
Suffix:
Gender:M
Credentials:LCSW & RPT
Other - Prefix:
Other - First Name:CLINT
Other - Middle Name:D
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:125 E 23RD ST STE 304
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4576
Mailing Address - Country:US
Mailing Address - Phone:937-307-8793
Mailing Address - Fax:
Practice Address - Street 1:125 E 23RD ST STE 304
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4576
Practice Address - Country:US
Practice Address - Phone:937-307-8793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1200134101YM0800X
NY094326104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health