Provider Demographics
NPI:1326687658
Name:CLIFFORD, MAGGIE ANN
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:ANN
Last Name:CLIFFORD
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 1:8443 LAVENHAM
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-2465
Mailing Address - Country:US
Mailing Address - Phone:210-897-8750
Mailing Address - Fax:210-261-1821
Practice Address - Street 1:18834 STONE OAK PKWY STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4177
Practice Address - Country:US
Practice Address - Phone:210-897-8750
Practice Address - Fax:833-478-1412
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX547211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical