Provider Demographics
NPI:1245397769
Name:CLAR, PHILIP N (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:N
Last Name:CLAR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:PHILIP
Other - Middle Name:NORMAN
Other - Last Name:CLAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4915 BRIGHTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0955
Mailing Address - Country:US
Mailing Address - Phone:916-966-8984
Mailing Address - Fax:
Practice Address - Street 1:10725 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-7967
Practice Address - Country:US
Practice Address - Phone:916-631-2455
Practice Address - Fax:916-631-2439
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 3839103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical