Basic Information
| Provider Information | |||||||||
| NPI: | 1700127149 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLAUSNITZER | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | HUGO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 86 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | GROVELAND | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018341533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086331479 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1115 W CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023017501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085804691 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2013 | ||||||||
| LastUpdateDate: | 03/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.