Provider Demographics
NPI:1942455837
Name:CLANCY, KATHLEEN MARY (LMFT)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARY
Last Name:CLANCY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BANK ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2806
Mailing Address - Country:US
Mailing Address - Phone:203-888-0462
Mailing Address - Fax:203-888-1465
Practice Address - Street 1:100 BANK ST
Practice Address - Street 2:SUITE 306
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-2806
Practice Address - Country:US
Practice Address - Phone:203-888-0462
Practice Address - Fax:203-888-1465
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96302106H00000X
CT001294106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist