Provider Demographics
NPI:1275180820
Name:MC CLOSKEY, TAYLOR MARIE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARIE
Last Name:MC CLOSKEY
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 1:417 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-5342
Mailing Address - Country:US
Mailing Address - Phone:909-228-9782
Mailing Address - Fax:
Practice Address - Street 1:417 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-5342
Practice Address - Country:US
Practice Address - Phone:909-228-9782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty