Provider Demographics
NPI:1033491097
Name:CLARKE, VENISA JULINE
Entity Type:Individual
Prefix:MS
First Name:VENISA
Middle Name:JULINE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VENISA
Other - Middle Name:JULINE
Other - Last Name:CLARKE-LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:161-01, 89TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:718-262-8190
Mailing Address - Fax:
Practice Address - Street 1:16101 89TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3902
Practice Address - Country:US
Practice Address - Phone:718-262-8190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator