Provider Demographics
NPI:1821196569
Name:CLANSY, PAULINE A (EDD)
Entity Type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:A
Last Name:CLANSY
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8303 SOUTHWEST FREEWAY
Mailing Address - Street 2:SUITE 640
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074
Mailing Address - Country:US
Mailing Address - Phone:713-777-8633
Mailing Address - Fax:713-777-5259
Practice Address - Street 1:8303 SOUTHWEST FREEWAY
Practice Address - Street 2:SUITE 640
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:713-777-8633
Practice Address - Fax:713-777-5259
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23329103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032855101Medicaid
4356701OtherAETNA
TX10016219OtherAMERIGROUP
TX760236166OtherMAGELLAN