Provider Demographics
NPI:1497232599
Name:CLAISE, MARLEY
Entity Type:Individual
Prefix:
First Name:MARLEY
Middle Name:
Last Name:CLAISE
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 1:10 DANA ST APT 410
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5415
Mailing Address - Country:US
Mailing Address - Phone:617-501-0664
Mailing Address - Fax:
Practice Address - Street 1:1100 WASHINGTON ST STE 206
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5520
Practice Address - Country:US
Practice Address - Phone:617-325-2993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor