Provider Demographics
NPI:1487741864
Name:CLANCY, ANNE (LICSW)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:CLANCY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 ENGLEWOOD AVE APT A
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7045
Mailing Address - Country:US
Mailing Address - Phone:617-232-4518
Mailing Address - Fax:
Practice Address - Street 1:139 BILLERICA RD
Practice Address - Street 2:SUITE C-2EAST
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3619
Practice Address - Country:US
Practice Address - Phone:978-244-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1000211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical