Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 012551 | NY |
Y | 103T00000X | Psychologist | 012551 | NY |
NPI | 1003086760 |
---|---|
Provider Name | Dr. Aileen Clark |
First Address | New York, NY 10003-3605 |
Second Address | New York, NY 10003-3605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2008 |
Last Update Date | 08/03/2008 |