Provider Demographics
NPI:1457838161
Name:MYRHOL-CLARKE, BRITT JESSICA
Entity Type:Individual
Prefix:
First Name:BRITT
Middle Name:JESSICA
Last Name:MYRHOL-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 1:39 CHURCHHILL DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3804
Mailing Address - Country:US
Mailing Address - Phone:718-490-7059
Mailing Address - Fax:718-667-2665
Practice Address - Street 1:777 SEAVIEW AVE BLDG 10
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3409
Practice Address - Country:US
Practice Address - Phone:718-667-2429
Practice Address - Fax:718-667-2665
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJP06912101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health