Provider Demographics
NPI:1659814952
Name:MYERS-CLARK, GLORIA ELAINE (MS)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:ELAINE
Last Name:MYERS-CLARK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:POCASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02559-2110
Mailing Address - Country:US
Mailing Address - Phone:508-564-9690
Mailing Address - Fax:508-564-9699
Practice Address - Street 1:830 COUNTY RD
Practice Address - Street 2:
Practice Address - City:POCASSET
Practice Address - State:MA
Practice Address - Zip Code:02559-2110
Practice Address - Country:US
Practice Address - Phone:508-564-9690
Practice Address - Fax:508-564-9699
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health