Healthcare Provider Details

I. General information

NPI: 1124054416
Provider Name (Legal Business Name): CLEO J. SENOR LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N MAIN ST SUITE 205
ATTLEBORO MA
02703-2248
US

IV. Provider business mailing address

101 H DARLING DR
NO ATTLEBORO MA
02760-4504
US

V. Phone/Fax

Practice location:
  • Phone: 401-524-7843
  • Fax:
Mailing address:
  • Phone: 401-524-7843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1018826
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01477
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: