Provider Demographics
NPI:1568777001
Name:CLARKE, CHARLINE
Entity Type:Individual
Prefix:MRS
First Name:CHARLINE
Middle Name:
Last Name: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 1:425 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2533
Mailing Address - Country:US
Mailing Address - Phone:617-694-7172
Mailing Address - Fax:508-425-3048
Practice Address - Street 1:425 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2533
Practice Address - Country:US
Practice Address - Phone:617-694-7172
Practice Address - Fax:508-425-3048
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1249071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical