Provider Demographics
NPI:1275839599
Name:CLARK, DANIELLE Y (NCP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:Y
Last Name:CLARK
Suffix:
Gender:F
Credentials:NCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E 2ND ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1537
Mailing Address - Country:US
Mailing Address - Phone:814-452-8300
Mailing Address - Fax:814-452-8308
Practice Address - Street 1:120 E 2ND ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1537
Practice Address - Country:US
Practice Address - Phone:814-452-8300
Practice Address - Fax:814-452-8308
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006184L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist