Provider Demographics
NPI:1851907216
Name:CLANCY, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CLANCY
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 1:2372 COOLIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-3902
Mailing Address - Country:US
Mailing Address - Phone:707-753-0715
Mailing Address - Fax:
Practice Address - Street 1:1408 8TH ST
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5115
Practice Address - Country:US
Practice Address - Phone:866-273-2451
Practice Address - Fax:866-608-5560
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst