Provider Demographics
NPI:1669402103
Name:CLANCY, CHRISTOPHER TODD (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:TODD
Last Name:CLANCY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S SAINT FRANCIS DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-3055
Mailing Address - Country:US
Mailing Address - Phone:505-370-4294
Mailing Address - Fax:505-212-1552
Practice Address - Street 1:103 S SAINT FRANCIS DR UNIT B
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-3055
Practice Address - Country:US
Practice Address - Phone:505-370-4294
Practice Address - Fax:505-212-1552
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00641122084P0804X
MA2102022084P0804X, 2084P0800X, 2084P0804X
NMMD2005-08452084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM40757323Medicaid
NYRB5860Medicare PIN
NMH50276Medicare UPIN
NYRB6480Medicare PIN
NM8HE457Medicare ID - Type Unspecified