Provider Demographics
NPI:1053414383
Name:CLIONSKY, EMILYMARIE (MD)
Entity type:Individual
Prefix:
First Name:EMILYMARIE
Middle Name:
Last Name:CLIONSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MAPLE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1828
Mailing Address - Country:US
Mailing Address - Phone:413-306-6060
Mailing Address - Fax:413-747-1558
Practice Address - Street 1:155 MAPLE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1828
Practice Address - Country:US
Practice Address - Phone:413-306-6060
Practice Address - Fax:413-747-1558
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13044207R00000X
NC200000807207R00000X
MA2336512084P0800X
NH130042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH22373Medicare UPIN