Provider Demographics
NPI:1932497146
Name:CLANCY, CONSTANCE SUZANNE (EDD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:SUZANNE
Last Name:CLANCY
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:PO BOX 82
Mailing Address - Street 2:
Mailing Address - City:SNOWMASS
Mailing Address - State:CO
Mailing Address - Zip Code:81654-0082
Mailing Address - Country:US
Mailing Address - Phone:970-376-4163
Mailing Address - Fax:
Practice Address - Street 1:135 W MAIN ST STE G
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1700
Practice Address - Country:US
Practice Address - Phone:970-376-4163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
FLMH1915174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No174400000XOther Service ProvidersSpecialist