Provider Demographics
NPI:1356951172
Name:PAK, CLARA Y
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:Y
Last Name:PAK
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 1:1255 E 4TH ST BETHLEHEM PA 18015
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015
Mailing Address - Country:US
Mailing Address - Phone:201-281-4677
Mailing Address - Fax:
Practice Address - Street 1:1330 PARKWAY AVE STE 7
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3006
Practice Address - Country:US
Practice Address - Phone:609-403-6359
Practice Address - Fax:609-357-9488
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00714200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty