Provider Demographics
NPI:1982475901
Name:MACANNAN, CLARE
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:
Last Name:MACANNAN
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 1:66 GLEBROOK ROAD
Mailing Address - Street 2:APT 1226
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-8402
Mailing Address - Country:US
Mailing Address - Phone:609-947-7369
Mailing Address - Fax:
Practice Address - Street 1:66 GLEBROOK ROAD
Practice Address - Street 2:APT 1226
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-8402
Practice Address - Country:US
Practice Address - Phone:609-947-7369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst