Provider Demographics
NPI:1861034019
Name:CASE, CLARENCE C
Entity Type:Individual
Prefix:
First Name:CLARENCE
Middle Name:C
Last Name:CASE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:VT
Mailing Address - Zip Code:05774-0067
Mailing Address - Country:US
Mailing Address - Phone:845-677-9069
Mailing Address - Fax:888-287-6382
Practice Address - Street 1:85 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:VT
Practice Address - Zip Code:05774
Practice Address - Country:US
Practice Address - Phone:845-677-9069
Practice Address - Fax:888-287-6382
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician