Provider Demographics
NPI:1851804231
Name:TILLEY, CLARA
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:TILLEY
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 1:64 BURKE ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-4818
Mailing Address - Country:US
Mailing Address - Phone:203-645-2863
Mailing Address - Fax:
Practice Address - Street 1:900 CHAPEL ST STE 1400
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2814
Practice Address - Country:US
Practice Address - Phone:203-787-2111
Practice Address - Fax:203-397-9077
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor