Provider Demographics
NPI:1659390425
Name:CLARKE, DONNA J (LCSW-C; LICSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LCSW-C; LICSW
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:101 ROUTE 130 S
Mailing Address - Street 2:STE 330
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-2853
Mailing Address - Country:US
Mailing Address - Phone:609-472-1091
Mailing Address - Fax:
Practice Address - Street 1:304 NEWTON AVE
Practice Address - Street 2:
Practice Address - City:OAKLYN
Practice Address - State:NJ
Practice Address - Zip Code:08107-1446
Practice Address - Country:US
Practice Address - Phone:609-472-1091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055733001041C0700X
PACW0177531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD455550300Medicaid
MD491460Medicare UPIN