Provider Demographics
NPI:1245638923
Name:CLARK, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:CLARK
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 1:905 DENSTON DR
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3901
Mailing Address - Country:US
Mailing Address - Phone:215-287-6381
Mailing Address - Fax:
Practice Address - Street 1:8302 OLD YORK RD
Practice Address - Street 2:B-12
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1522
Practice Address - Country:US
Practice Address - Phone:215-885-9700
Practice Address - Fax:215-886-7678
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0178871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical