Provider Demographics
NPI:1255905303
Name:CLANCY, ERIN (LICSW)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:CLANCY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MAIN STREET
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-2463
Mailing Address - Country:US
Mailing Address - Phone:774-509-5059
Mailing Address - Fax:774-250-2693
Practice Address - Street 1:20 CABOT BLVD STE 227
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1183
Practice Address - Country:US
Practice Address - Phone:508-589-5333
Practice Address - Fax:774-250-2693
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MALICSW1281541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker