Provider Demographics
NPI:1386650372
Name:CLARKE, ROSEMARY ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:ELLEN
Last Name:CLARKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7709 CONSTITUTION AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7546
Mailing Address - Country:US
Mailing Address - Phone:505-271-1884
Mailing Address - Fax:505-271-0039
Practice Address - Street 1:7709 CONSTITUTION AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7546
Practice Address - Country:US
Practice Address - Phone:505-271-1884
Practice Address - Fax:505-271-0039
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLPCC #94101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM545406Medicaid