Provider Demographics
NPI:1730751462
Name:CLONTS, ANA GABRIELA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:GABRIELA
Last Name:CLONTS
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 1:3 MIDDLE SCHOOL LANE
Mailing Address - Street 2:06070 SIMSBURY CT
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070
Mailing Address - Country:US
Mailing Address - Phone:928-792-8008
Mailing Address - Fax:
Practice Address - Street 1:3 MIDDLE SCHOOL LANE
Practice Address - Street 2:06070 SIMSBURY CT
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-0607
Practice Address - Country:US
Practice Address - Phone:928-792-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT149310685106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician