Provider Demographics
NPI:1306656640
Name:CLARKSON, JUSTIN BRADLEY
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:BRADLEY
Last Name:CLARKSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WARREGAN ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-2356
Mailing Address - Country:US
Mailing Address - Phone:413-388-8709
Mailing Address - Fax:
Practice Address - Street 1:117 WARREGAN ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-2356
Practice Address - Country:US
Practice Address - Phone:413-388-8709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician