Provider Demographics
NPI:1740539691
Name:CLARK, AMARA (LCAT, ATR-BC)
Entity type:Individual
Prefix:MS
First Name:AMARA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:LCAT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 LORIMER ST BSMT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-2907
Mailing Address - Country:US
Mailing Address - Phone:917-765-5548
Mailing Address - Fax:917-924-5772
Practice Address - Street 1:163 LORIMER ST BSMT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2907
Practice Address - Country:US
Practice Address - Phone:917-765-5548
Practice Address - Fax:917-924-5772
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001728221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist