Provider Demographics
NPI:1427537786
Name:CLARKE PSYCHOLOGICAL LLC
Entity Type:Organization
Organization Name:CLARKE PSYCHOLOGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-297-0735
Mailing Address - Street 1:1200 EASTWOOD DR STE 2
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8824
Mailing Address - Country:US
Mailing Address - Phone:814-297-0735
Mailing Address - Fax:
Practice Address - Street 1:1200 EASTWOOD DR STE 2
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8824
Practice Address - Country:US
Practice Address - Phone:814-297-0735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018506251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health