Provider Demographics
NPI:1043983869
Name:CLARK, CARA A
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:A
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SALMAR AVE
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1322
Mailing Address - Country:US
Mailing Address - Phone:914-261-3180
Mailing Address - Fax:
Practice Address - Street 1:ROCKLAND BOCES
Practice Address - Street 2:65 PARROTT RD
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994
Practice Address - Country:US
Practice Address - Phone:845-627-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY473158-1163WA0400X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)