Provider Demographics
NPI:1427281872
Name:CLANCY, DOROTHY JEAN (MS, CNS)
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:JEAN
Last Name:CLANCY
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10958 EIGHT BELLS LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2704
Mailing Address - Country:US
Mailing Address - Phone:301-996-0417
Mailing Address - Fax:
Practice Address - Street 1:10958 EIGHT BELLS LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2704
Practice Address - Country:US
Practice Address - Phone:301-996-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2975133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist