Individual
CONSTANCE J. CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNCS
Contact information
Practice address
111 GROSSMAN DR, BRAINTREE, MA 02184-4997
(781) 849-2275
Mailing address
147 MILK ST, PROVIDER ENROLLMENT 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8051
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
144849
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
669492
TUFTS HEALTH PLAN
MA
01
—
PN0053
BLUE CROSS
MA
Enumeration date
08/04/2006
Last updated
04/10/2009
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