Provider Demographics
NPI:1780156786
Name:VLIEGER, EILEEN CLOUGHERTY
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:CLOUGHERTY
Last Name:VLIEGER
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 1:5 DONOVAN LN
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3616
Mailing Address - Country:US
Mailing Address - Phone:857-492-6956
Mailing Address - Fax:
Practice Address - Street 1:70 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4506
Practice Address - Country:US
Practice Address - Phone:781-961-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1131611041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool