Provider Demographics
NPI:1710133863
Name:CLOUGH, MARC (MED CAGS LEP LMHC)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:CLOUGH
Suffix:
Gender:M
Credentials:MED CAGS LEP LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MAIN ST UNIT 213
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1584
Mailing Address - Country:US
Mailing Address - Phone:508-254-9203
Mailing Address - Fax:774-929-9350
Practice Address - Street 1:165 MAIN ST UNIT 213
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1584
Practice Address - Country:US
Practice Address - Phone:508-254-9203
Practice Address - Fax:774-929-9350
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA895103TS0200X
MA7371101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool