Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003285172 |
---|---|
Provider Name | Katherine Clarke |
First Address | Hawthorne, NY 10532-1313 |
Second Address | Hawthorne, NY 10532-1313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2015 |
Last Update Date | 18/09/2015 |