Provider Demographics
NPI:1568723807
Name:CLARKE, LINDSAY T (MED, LABA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:T
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MED, LABA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MATTHEWS LNDG
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-1999
Mailing Address - Country:US
Mailing Address - Phone:508-858-6332
Mailing Address - Fax:
Practice Address - Street 1:33 MATTHEWS LNDG
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-1999
Practice Address - Country:US
Practice Address - Phone:508-858-6332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MA1859103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst