Provider Demographics
NPI:1659737104
Name:CLANCY, KATE-LYNN BREAULT (BCBA)
Entity Type:Individual
Prefix:
First Name:KATE-LYNN
Middle Name:BREAULT
Last Name:CLANCY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KATE-LYNN
Other - Middle Name:
Other - Last Name:BREAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 HMS STAYNER DR
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-1664
Mailing Address - Country:US
Mailing Address - Phone:617-957-6451
Mailing Address - Fax:781-385-7324
Practice Address - Street 1:105 HMS STAYNER DR
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1664
Practice Address - Country:US
Practice Address - Phone:617-957-6451
Practice Address - Fax:781-385-7324
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALABA3634103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst