Provider Demographics
NPI:1275975864
Name:CLARKE, HEATHER N (MA(ECON), MSC, MSPED)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:N
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MA(ECON), MSC, MSPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3047 HOBART ST
Mailing Address - Street 2:APT 3J
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1463
Mailing Address - Country:US
Mailing Address - Phone:347-684-7067
Mailing Address - Fax:
Practice Address - Street 1:3047 HOBART ST
Practice Address - Street 2:APT 3J
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-1463
Practice Address - Country:US
Practice Address - Phone:347-684-7067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY399317171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor