Individual
CLARENCE D GONSALVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
321 BLUE HILL AVE, BOSTON, MA 02121-4302
(617) 541-6859
Mailing address
84 MOUNT VERNON ST # 2, MALDEN, MA 02148-6714
(857) 247-7425
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
S71703937
MA
Other
Enumeration date
05/02/2008
Last updated
05/23/2011
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