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General NPI Number Information
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NPI Number | 1417786682
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Entity Type | Individual
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Provider Name | MR. PARKER MACKENZIE CLEARY
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Gender | Male
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Dates
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Enumeration Date | 07/29/2024
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 1 CENTRE ST FL 3
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City | BROCKTON
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State | MA
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Zip | 02301-4092
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Country | US
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Telephone | 508-510-4483
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Fax |
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Provider Business Mailing Address
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Address Line | 734 PALMER AVE
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City | FALMOUTH
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State | MA
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Zip | 02540-3024
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Country | US
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Telephone | 508-524-4944
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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