Provider Demographics
NPI:1710741665
Name:BESECE, CLARK
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:
Last Name:BESECE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:RAYLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43943-9602
Mailing Address - Country:US
Mailing Address - Phone:740-310-7770
Mailing Address - Fax:
Practice Address - Street 1:105 CHURCH ST
Practice Address - Street 2:
Practice Address - City:RAYLAND
Practice Address - State:OH
Practice Address - Zip Code:43943-9602
Practice Address - Country:US
Practice Address - Phone:740-310-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker