Provider Demographics
NPI:1952653594
Name:CLARKE, JENNIFER YVETTE (MS SP ED)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:YVETTE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MS SP ED
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:YVETTE
Other - Last Name:CYRUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:5722 AVENUE L
Mailing Address - Street 2:572
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3320
Mailing Address - Country:US
Mailing Address - Phone:718-209-4551
Mailing Address - Fax:
Practice Address - Street 1:5722 AVENUE L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3320
Practice Address - Country:US
Practice Address - Phone:718-209-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYSOCIAL SECURITY #174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist