Provider Demographics
NPI:1043689326
Name:CLARKSON, AMY LYN (MT-BC, CP, LCAT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYN
Last Name:CLARKSON
Suffix:
Gender:F
Credentials:MT-BC, CP, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2535
Mailing Address - Country:US
Mailing Address - Phone:908-240-4202
Mailing Address - Fax:
Practice Address - Street 1:770 ROUTE 206
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08844-9807
Practice Address - Country:US
Practice Address - Phone:908-255-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000825-1225A00000X
225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist