Provider Demographics
NPI:1073995502
Name:CLARKE, VINCENT (BA)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:CLARKE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11215 SW 138TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-6420
Mailing Address - Country:US
Mailing Address - Phone:305-378-5633
Mailing Address - Fax:
Practice Address - Street 1:7392 NW 35TH TER STE 201-202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1271
Practice Address - Country:US
Practice Address - Phone:305-597-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-21
Last Update Date:2015-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker