Provider Demographics
NPI:1477056158
Name:CLANCY, BARBARA A
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:CLANCY
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 1:6 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1487
Mailing Address - Country:US
Mailing Address - Phone:774-269-8640
Mailing Address - Fax:
Practice Address - Street 1:199 REEDSDALE RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3926
Practice Address - Country:US
Practice Address - Phone:617-698-6334
Practice Address - Fax:617-698-6334
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C52053222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist