Provider Demographics
NPI:1114496858
Name:CLARK, TROY J
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:J
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 1:4909 VERONA RD APT 9
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:PA
Mailing Address - Zip Code:15147-3046
Mailing Address - Country:US
Mailing Address - Phone:412-706-4354
Mailing Address - Fax:
Practice Address - Street 1:4909 VERONA RD APT 9
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:PA
Practice Address - Zip Code:15147-3046
Practice Address - Country:US
Practice Address - Phone:412-706-4354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-23
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health