Provider Demographics
NPI:1700943784
Name:CLUCAS, EMILIE J (MSW INTERN)
Entity Type:Individual
Prefix:MS
First Name:EMILIE
Middle Name:J
Last Name:CLUCAS
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 UNDINE AVE
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2562
Mailing Address - Country:US
Mailing Address - Phone:617-846-0302
Mailing Address - Fax:
Practice Address - Street 1:172 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3750
Practice Address - Country:US
Practice Address - Phone:508-770-0511
Practice Address - Fax:508-770-0875
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program