Provider Demographics
NPI:1710098322
Name:CLARKE, SHARON (MSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E 2ND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1880
Mailing Address - Country:US
Mailing Address - Phone:484-534-9686
Mailing Address - Fax:610-828-4910
Practice Address - Street 1:20 E 2ND AVE STE 100
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1880
Practice Address - Country:US
Practice Address - Phone:484-534-9686
Practice Address - Fax:610-828-4910
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10178741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA230603000OtherKEYSTONE
PA2321123000OtherIBC
PA7548294OtherAETNA