Provider Demographics
NPI:1003598202
Name:CLAY, EMMA (RN)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:CLAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:95 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1524
Mailing Address - Country:US
Mailing Address - Phone:800-988-1111
Mailing Address - Fax:
Practice Address - Street 1:125 HARTWELL AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-3100
Practice Address - Country:US
Practice Address - Phone:781-861-0890
Practice Address - Fax:781-592-0581
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MARN2339390363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health