Provider Demographics
NPI:1578004065
Name:CLARK, LORENE
Entity Type:Individual
Prefix:
First Name:LORENE
Middle Name:
Last Name:CLARK
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 1:4111 LINNELL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2728
Mailing Address - Country:US
Mailing Address - Phone:216-682-5257
Mailing Address - Fax:
Practice Address - Street 1:3100 E 45TH ST STE 438
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127
Practice Address - Country:US
Practice Address - Phone:216-213-1862
Practice Address - Fax:440-848-8372
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator