Provider Demographics
NPI:1851511919
Name:CLARKE, DAVID ERNEST (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERNEST
Last Name:CLARKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13304 WINDING OAK COURT
Mailing Address - Street 2:SUITE A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612
Mailing Address - Country:US
Mailing Address - Phone:813-930-2927
Mailing Address - Fax:602-277-8146
Practice Address - Street 1:13304 WINDING OAK COURT
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-930-2927
Practice Address - Fax:602-277-8146
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4066103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical