Provider Demographics
NPI:1205374923
Name:CLARK, JARAE (ASW)
Entity Type:Individual
Prefix:
First Name:JARAE
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-3101
Mailing Address - Country:US
Mailing Address - Phone:415-822-7500
Mailing Address - Fax:415-822-9767
Practice Address - Street 1:5815 3RD ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124
Practice Address - Country:US
Practice Address - Phone:415-822-7500
Practice Address - Fax:415-822-9767
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor