1235430588 NPI number — MRS. PATRICIA ANN CLOUGH MS, LMFT

Table of content: MRS. PATRICIA ANN CLOUGH MS, LMFT (NPI 1235430588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235430588 NPI number — MRS. PATRICIA ANN CLOUGH MS, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLOUGH
Provider First Name:
PATRICIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLOUGH
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1235430588
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 SMITH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04027-3122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-842-2309
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 N MAIN ST UNIT 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03867-1964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-481-0921
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  133 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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