Provider Demographics
NPI:1215019146
Name:IVERS, CLIFFORD LAWRENCE (PHD)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:LAWRENCE
Last Name:IVERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:600 OSWEGO STREET SUITE A
Mailing Address - Street 2:CLIFFORD IVERS PHD
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088
Mailing Address - Country:US
Mailing Address - Phone:315-451-0202
Mailing Address - Fax:315-451-6667
Practice Address - Street 1:600 OSWEGO STREET SUITE A
Practice Address - Street 2:CLIFFORD IVERS PHD
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088
Practice Address - Country:US
Practice Address - Phone:315-451-0202
Practice Address - Fax:315-451-6667
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010749103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical