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General NPI Number Information
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NPI Number | 1366602807
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Entity Type | Organization
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Legal Business Name | THE CLEARLIGHT CENTER, INC.
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 24 GEORGETOWN RD
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City | BOXFORD
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State | MA
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Zip | 01921-2333
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Country | US
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Telephone | 978-887-2977
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 345
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City | BOXFORD
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State | MA
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Zip | 01921-0345
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Country | US
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Telephone | 978-887-2977
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHANIE S. SIDNEY
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Credential | PSY.D.
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Telephone | 978-887-2977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3398
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License Number State | MA
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