Provider Demographics
NPI:1346961398
Name:CLARKE, JOSEPH (LSW)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:CLARKE
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 BIDLACK ST
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4121
Mailing Address - Country:US
Mailing Address - Phone:570-762-4366
Mailing Address - Fax:
Practice Address - Street 1:48 BIDLACK ST
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4121
Practice Address - Country:US
Practice Address - Phone:570-762-4366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW137674104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker