Provider Demographics
NPI:1093014698
Name:CLARK, MARGUERITE MCCARTIN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARGUERITE
Middle Name:MCCARTIN
Last Name:CLARK
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Gender:F
Credentials:MA, CCC-SLP
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Mailing Address - Street 1:998 CROOKED HILL RD
Mailing Address - Street 2:BUILDING 25
Mailing Address - City:WEST BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-1019
Mailing Address - Country:US
Mailing Address - Phone:631-761-3500
Mailing Address - Fax:631-761-3674
Practice Address - Street 1:998 CROOKED HILL RD
Practice Address - Street 2:BUILDING 25
Practice Address - City:WEST BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1019
Practice Address - Country:US
Practice Address - Phone:631-761-3500
Practice Address - Fax:631-761-3674
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY002159-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist