Provider Demographics
NPI:1619950433
Name:CLARK, DANA FARENGO (MS, CGC)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:FARENGO
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:ANN
Other - Last Name:FARENGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11 E DELAWARE TRL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8948
Mailing Address - Country:US
Mailing Address - Phone:856-325-6716
Mailing Address - Fax:856-325-6557
Practice Address - Street 1:900 CENTENNIAL BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4689
Practice Address - Country:US
Practice Address - Phone:856-325-6716
Practice Address - Fax:856-325-6557
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS