Individual
MS. DEBORAH OLDS CLENDANIEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1666 MASSACHUSETTS AVE, LEXINGTON, MA 02420-5317
(781) 863-1124
Mailing address
55 ALCOTT RD, CONCORD, MA 01742-2642
(781) 863-1124
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
110820
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2348843000
MAGELLAN BEHAVORIAL HEALT
MA
01
—
P07992
BLUE CROSS BLUE SHIELD
MA
Enumeration date
01/03/2007
Last updated
07/08/2007
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