Provider Demographics
NPI:1649810318
Name:CLIFFORD, MARY ELLEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELLEN
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 ORANGE TPKE
Mailing Address - Street 2:
Mailing Address - City:SLOATSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10974-1907
Mailing Address - Country:US
Mailing Address - Phone:914-906-2965
Mailing Address - Fax:
Practice Address - Street 1:93 ORANGE TPKE
Practice Address - Street 2:
Practice Address - City:SLOATSBURG
Practice Address - State:NY
Practice Address - Zip Code:10974-1907
Practice Address - Country:US
Practice Address - Phone:914-906-2965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017001103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical