Provider Demographics
NPI:1982212395
Name:CLARKE, JANICE ALICIA (CLC)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:ALICIA
Last Name:CLARKE
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:MS
Other - First Name:JANICE
Other - Middle Name:ALICIA
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:276 5TH AVE RM 704
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4527
Mailing Address - Country:US
Mailing Address - Phone:347-948-5769
Mailing Address - Fax:
Practice Address - Street 1:4 FORDHAM HILL OVAL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-4716
Practice Address - Country:US
Practice Address - Phone:347-701-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN