Provider Demographics
NPI:1902290463
Name:CLANCEY, MARY L (LMT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:CLANCEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:L
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 943
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03848-0943
Mailing Address - Country:US
Mailing Address - Phone:603-661-4718
Mailing Address - Fax:
Practice Address - Street 1:111 CANAL ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-4649
Practice Address - Country:US
Practice Address - Phone:978-825-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10427225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist