Provider Demographics
NPI:1477719060
Name:ROE F CLARKE PSY D P A
Entity Type:Organization
Organization Name:ROE F CLARKE PSY D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ROE
Authorized Official - Middle Name:F
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D P A
Authorized Official - Phone:954-588-7107
Mailing Address - Street 1:950 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 1050
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3918
Mailing Address - Country:US
Mailing Address - Phone:954-588-7107
Mailing Address - Fax:
Practice Address - Street 1:950 S PINE ISLAND RD
Practice Address - Street 2:SUITE 1050
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3918
Practice Address - Country:US
Practice Address - Phone:954-588-7107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-02
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4970103TA0700X, 103TB0200X, 103TC0700X, 103TF0000X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS67692Medicare UPIN