Provider Demographics
NPI:1619366390
Name:CLANCY, CAROL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:CLANCY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 VETERANS BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1499
Mailing Address - Country:US
Mailing Address - Phone:650-307-2196
Mailing Address - Fax:
Practice Address - Street 1:611 VETERANS BLVD STE 116
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1499
Practice Address - Country:US
Practice Address - Phone:650-307-2196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-17
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20250103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist