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General NPI Number Information
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NPI Number | 1629400478
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Entity Type | Organization
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Legal Business Name | MARY CLANCY NP, LLC
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Dates
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Enumeration Date | 08/04/2013
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Last Update Date | 08/04/2013
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Provider Practice Location Address
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Address Line | 1290 WORCESTER RD
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City | FRAMINGHAM
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State | MA
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Zip | 01702-5254
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Country | US
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Telephone | 508-872-6228
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Fax |
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Provider Business Mailing Address
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Address Line | 7 LOMAS CIR
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City | FRAMINGHAM
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State | MA
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Zip | 01701-3949
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Country | US
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Telephone | 508-872-6228
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Fax |
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Authorized Official
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Title or Position | DIRECT OWNER
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Name | MRS. MARY CLANCY
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Credential | NP
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Telephone | 508-877-6318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | RN159848
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License Number State | MA
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