Provider Demographics
NPI:1568572790
Name:CLARK, PENNY LOUISE (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:LOUISE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6A ASPEN PLZ
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5001
Mailing Address - Country:US
Mailing Address - Phone:732-850-1802
Mailing Address - Fax:
Practice Address - Street 1:221 PALISADE AVE
Practice Address - Street 2:PALISADE BEHAVIORAL CARE
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-656-3116
Practice Address - Fax:201-656-9044
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00319000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional