Provider Demographics
NPI:1710594163
Name:CLIFFORD, JACLYN F
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:F
Last Name:CLIFFORD
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 1:465 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-2914
Mailing Address - Country:US
Mailing Address - Phone:508-577-6227
Mailing Address - Fax:
Practice Address - Street 1:465 FOREST ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-2914
Practice Address - Country:US
Practice Address - Phone:508-577-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program