Provider Demographics
NPI:1710133863
Name:CLOUGH, MARC (MED, CAGS, LEP)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:CLOUGH
Suffix:
Gender:M
Credentials:MED, CAGS, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 UNCAS AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-3504
Mailing Address - Country:US
Mailing Address - Phone:508-254-9203
Mailing Address - Fax:774-929-9350
Practice Address - Street 1:19 UNCAS AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-3504
Practice Address - Country:US
Practice Address - Phone:508-254-9203
Practice Address - Fax:774-929-9350
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA895103TS0200X
MA7371101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool