Provider Demographics
NPI:1881069243
Name:CLARKE, LUCILLE (LCSW-BACS)
Entity type:Individual
Prefix:
First Name:LUCILLE
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 POYDRAS ST STE 923
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1254
Mailing Address - Country:US
Mailing Address - Phone:504-777-6871
Mailing Address - Fax:504-617-7813
Practice Address - Street 1:1615 POYDRAS ST STE 923
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1254
Practice Address - Country:US
Practice Address - Phone:504-777-6871
Practice Address - Fax:504-617-7813
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA33081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical