Individual
JOANN MCCLUSKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
52B WAYSIDE AVE, WEST SPRINGFIELD, MA 01089-1316
(413) 427-9980
Mailing address
52-B WAYSIDE AVE, WEST SPRINGFIELD, MA 01089
(413) 427-9980
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
—
—
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MASS
—
MA
Enumeration date
09/03/2015
Last updated
09/03/2015
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