Provider Demographics
NPI:1710995139
Name:VANNEST, CLIFFORD VINCENT (MA)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:VINCENT
Last Name:VANNEST
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:CLIFF
Other - Middle Name:V
Other - Last Name:VAN NEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1405 JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-4573
Mailing Address - Country:US
Mailing Address - Phone:732-899-6488
Mailing Address - Fax:
Practice Address - Street 1:1868 ROUTE 88
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3535
Practice Address - Country:US
Practice Address - Phone:732-259-9544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37RC00121200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health