Provider Demographics
NPI:1962661124
Name:CLAGUE, JACQUELYN (MS)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:CLAGUE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:
Other - Last Name:BARTLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-4006
Mailing Address - Country:US
Mailing Address - Phone:781-584-2034
Mailing Address - Fax:
Practice Address - Street 1:10 HOWARD ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-4006
Practice Address - Country:US
Practice Address - Phone:781-584-2034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health