Doctor Name: | SUSAN CLEMENT |
NPI Number: | 1376945949 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 12160 |
Business Practice Address: | 19 Pine Rd Forestdale, MA - 026441413 |
Business Phone Number: | 7742282420 |
Business Fax Number: | |
Mailing Address: | 19 Pine Rd, FORESTDALE |
State: | MA |
Postal Code: | 026441413 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/25/2014 |
NPI Last Update Date: | 10/01/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 12160 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |