Healthcare Provider Details

I. General information

NPI: 1669402103
Provider Name (Legal Business Name): CHRISTOPHER TODD CLANCY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S SAINT FRANCIS DR UNIT B
SANTA FE NM
87501-3055
US

IV. Provider business mailing address

103 S SAINT FRANCIS DR UNIT B
SANTA FE NM
87501-3055
US

V. Phone/Fax

Practice location:
  • Phone: 505-370-4294
  • Fax: 505-212-1552
Mailing address:
  • Phone: 505-370-4294
  • Fax: 505-212-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberDR.0064112
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number210202
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2005-0845
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number210202
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: