Provider Demographics
NPI:1326405143
Name:PINSON, CLARK (PHD)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:
Last Name:PINSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 DEWITT ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2801
Mailing Address - Country:US
Mailing Address - Phone:315-514-0401
Mailing Address - Fax:315-565-5122
Practice Address - Street 1:135 DEWITT ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2801
Practice Address - Country:US
Practice Address - Phone:315-514-0401
Practice Address - Fax:315-565-5122
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020187103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling