Provider Demographics
NPI:1033275177
Name:BARKAN CLARKE, JACQUELINE MIA (MA, ATR-BC, LCAT)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MIA
Last Name:BARKAN CLARKE
Suffix:
Gender:F
Credentials:MA, ATR-BC, LCAT
Other - Prefix:MS
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:BARKAN CLARKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, ATR-BC, LCAT
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-0127
Mailing Address - Country:US
Mailing Address - Phone:845-559-4922
Mailing Address - Fax:
Practice Address - Street 1:2000 FISHER AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3407
Practice Address - Country:US
Practice Address - Phone:845-559-4922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000031221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist