Healthcare Provider Details

I. General information

NPI: 1164357620
Provider Name (Legal Business Name): HANNAH CLINTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CRESCENT AVE
CHELSEA MA
02150-3009
US

IV. Provider business mailing address

1363 COMMONWEALTH AVE APT 2
ALLSTON MA
02134-3309
US

V. Phone/Fax

Practice location:
  • Phone: 617-889-8779
  • Fax:
Mailing address:
  • Phone: 781-710-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: