Provider Demographics
NPI:1710057880
Name:CLOUTIER, MARCI (PHD)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:CLOUTIER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARCI
Other - Middle Name:
Other - Last Name:MRYKALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:38 W CEDAR ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-1212
Mailing Address - Country:US
Mailing Address - Phone:617-645-7220
Mailing Address - Fax:
Practice Address - Street 1:10 OAK ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2409
Practice Address - Country:US
Practice Address - Phone:877-283-7863
Practice Address - Fax:877-656-4541
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8635103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist