Provider Demographics
NPI:1831429554
Name:CLARKE, VIVENE (SPED MS)
Entity type:Individual
Prefix:MRS
First Name:VIVENE
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:SPED MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 E 58TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4119
Mailing Address - Country:US
Mailing Address - Phone:718-531-0515
Mailing Address - Fax:
Practice Address - Street 1:1419 E 58TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4119
Practice Address - Country:US
Practice Address - Phone:718-531-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYSPECIAL ED171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor