Provider Demographics
NPI:1164547881
Name:CLARKE, KATHLEEN MAFFETT (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MAFFETT
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 E BASELINE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1404
Mailing Address - Country:US
Mailing Address - Phone:480-228-8933
Mailing Address - Fax:
Practice Address - Street 1:1250 E BASELINE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1404
Practice Address - Country:US
Practice Address - Phone:480-228-8933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ110441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical