Provider Demographics
NPI:1902400955
Name:ARBUCKLE, CLARISSA
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:ARBUCKLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 CARPENTERS CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:CLARKS MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:16114-1902
Mailing Address - Country:US
Mailing Address - Phone:724-253-4276
Mailing Address - Fax:
Practice Address - Street 1:60B FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-5118
Practice Address - Country:US
Practice Address - Phone:724-269-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor