Provider Demographics
NPI:1760699128
Name:CLARK, ERIN ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:ELIZABETH
Last Name:CLARK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:ELIZABETH
Other - Last Name:BAKEWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1562 BLACK WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-7984
Mailing Address - Country:US
Mailing Address - Phone:760-683-9058
Mailing Address - Fax:
Practice Address - Street 1:2850 PIO PICO DR
Practice Address - Street 2:SUITE J
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1554
Practice Address - Country:US
Practice Address - Phone:760-683-9058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48385106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist