Provider Demographics
NPI:1578062295
Name:CLARKE, MEGAN MAUREEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:MAUREEN
Last Name:CLARKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MIDLANDS DR
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1022
Mailing Address - Country:US
Mailing Address - Phone:860-470-4560
Mailing Address - Fax:
Practice Address - Street 1:3 FOREST PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1468
Practice Address - Country:US
Practice Address - Phone:860-470-4560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8.003717103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist