Provider Demographics
NPI:1164758009
Name:CLARKE, DIAON M (LCSW-R)
Entity Type:Individual
Prefix:DR
First Name:DIAON
Middle Name:M
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GRAMATAN AVE STE 607
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-3208
Mailing Address - Country:US
Mailing Address - Phone:917-604-6438
Mailing Address - Fax:
Practice Address - Street 1:6 GRAMATAN AVE STE 607
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-3208
Practice Address - Country:US
Practice Address - Phone:914-837-8336
Practice Address - Fax:914-560-2135
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0804201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1285628552OtherAGENCY
NY1295878577Medicaid