Provider Demographics
NPI:1336652890
Name:CLARKE, C.VANESSA
Entity Type:Individual
Prefix:
First Name:C.VANESSA
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HOWE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4620
Mailing Address - Country:US
Mailing Address - Phone:203-624-2525
Mailing Address - Fax:203-397-9077
Practice Address - Street 1:48 HOWE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4620
Practice Address - Country:US
Practice Address - Phone:203-624-2525
Practice Address - Fax:203-397-0977
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor