Provider Demographics
NPI:1588854293
Name:CLOONEY, DEBRA MAUREEN
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:MAUREEN
Last Name:CLOONEY
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 1:125 NASHUA ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-1101
Mailing Address - Country:US
Mailing Address - Phone:617-573-2990
Mailing Address - Fax:
Practice Address - Street 1:63 BRADLEY RD
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02191-1901
Practice Address - Country:US
Practice Address - Phone:781-331-6265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-29
Last Update Date:2007-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17862283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital