Provider Demographics
NPI:1073149167
Name:CLARK, REBECCA MARIA (MS, LCGC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:MARIA
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 S HIGHLAND AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-5204
Mailing Address - Country:US
Mailing Address - Phone:724-882-5584
Mailing Address - Fax:
Practice Address - Street 1:UPMC CHILDREN'S HOSPITAL OF PITTSBURGH
Practice Address - Street 2:4401 PENN AVENUE
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1334
Practice Address - Country:US
Practice Address - Phone:412-692-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAGC000549170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS