Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 083526 | NY |
NPI | 1003108408 |
---|---|
Provider Name | Tanya Michelle Clarke |
First Address | Glendale, NY 11385-7063 |
Second Address | Glendale, NY 11385-7063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2011 |
Last Update Date | 04/05/2011 |