Provider Demographics
NPI:1235597576
Name:CLAIRVIL, EMLINE
Entity Type:Individual
Prefix:
First Name:EMLINE
Middle Name:
Last Name:CLAIRVIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 CANTON ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-1506
Mailing Address - Country:US
Mailing Address - Phone:857-247-8293
Mailing Address - Fax:
Practice Address - Street 1:278 CANTON ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-1506
Practice Address - Country:US
Practice Address - Phone:857-247-8293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health