Provider Demographics
NPI:1962713305
Name:CLARK, HADLEY TIMMONS (MAOM, LIC AC)
Entity type:Individual
Prefix:
First Name:HADLEY
Middle Name:TIMMONS
Last Name:CLARK
Suffix:
Gender:F
Credentials:MAOM, LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2420
Mailing Address - Country:US
Mailing Address - Phone:802-356-5335
Mailing Address - Fax:
Practice Address - Street 1:93 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-2420
Practice Address - Country:US
Practice Address - Phone:802-356-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist