Provider Demographics
NPI:1952320582
Name:CLARKE, PAULA D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:D
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 W ALAMEDA AVE
Mailing Address - Street 2:#201
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2575
Mailing Address - Country:US
Mailing Address - Phone:661-877-8113
Mailing Address - Fax:818-842-1370
Practice Address - Street 1:30056 CALLE CERRITOS
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-1453
Practice Address - Country:US
Practice Address - Phone:661-877-8113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS210041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW21004Medicare ID - Type UnspecifiedLCSW