Provider Demographics
NPI:1407058688
Name:CLARKE, CYNTHIA (LIC AC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:MS
Other - First Name:SAVITRI
Other - Middle Name:
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LIC AC
Mailing Address - Street 1:103 MINUTEMAN DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-1923
Mailing Address - Country:US
Mailing Address - Phone:978-369-7600
Mailing Address - Fax:
Practice Address - Street 1:103 MINUTEMAN DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-1923
Practice Address - Country:US
Practice Address - Phone:978-369-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0005171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist