Provider Demographics
NPI:1780824821
Name:WILLIS, CLAIRE (LICSW)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 WESTFORD RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-5236
Mailing Address - Country:US
Mailing Address - Phone:978-341-0244
Mailing Address - Fax:
Practice Address - Street 1:362 WESTFORD RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-5236
Practice Address - Country:US
Practice Address - Phone:978-341-0244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1119791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical