Provider Demographics
NPI:1891258760
Name:CLAIRMONT, MARY ANNE
Entity Type:Individual
Prefix:
First Name:MARY ANNE
Middle Name:
Last Name:CLAIRMONT
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 1:3127 COLONY LN
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1928
Mailing Address - Country:US
Mailing Address - Phone:610-405-5320
Mailing Address - Fax:
Practice Address - Street 1:3127 COLONY LN
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1928
Practice Address - Country:US
Practice Address - Phone:610-405-5320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000274133V00000X
PAPC010141101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered