Provider Demographics
NPI:1801032792
Name:CLARK, STEVE
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:CLARK
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 1:516 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3707
Mailing Address - Country:US
Mailing Address - Phone:718-693-0200
Mailing Address - Fax:718-693-0752
Practice Address - Street 1:516 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3707
Practice Address - Country:US
Practice Address - Phone:718-693-0200
Practice Address - Fax:718-693-0752
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)