Provider Demographics
NPI:1437494267
Name:DENNIS, CLARENCE T (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:T
Last Name:DENNIS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-0369
Mailing Address - Country:US
Mailing Address - Phone:617-661-5515
Mailing Address - Fax:617-661-5182
Practice Address - Street 1:1234 HYDE PARK AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2819
Practice Address - Country:US
Practice Address - Phone:617-413-6618
Practice Address - Fax:617-333-8229
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA274554363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health