Charles Clark CASAC

NPI 1588981542 - Counselor - 101YA0400X

NPI Details
NPI 1588981542
Gender Male
Enumeration Date 04/29/2010
Last Updated 04/29/2010
Entity Type Individual
Active Over 6 years ago
Practice Location
2640 PITKIN AVE
BROOKLYN NY, 11208-2629, US
Phone (718) 827-8700
Fax (718) 827-8848
Business Location
2640 PITKIN AVE
BROOKLYN NY, 11208-2629, US
Phone (718) 827-8700
Fax (718) 827-8848
Toxanomy
Taxonomy Code 101YA0400X
License State New York
License Number 17173
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According to our database, Charles Clark CASAC NPI is 1588981542, taxonomy code is 101YA0400X and license number is 17173, license state is located at New York. Charles Clark CASAC physically located at 2640 Pitkin Ave, Brooklyn NY, 11208-2629. NPI Number Charles Clark CASAC has the Individual type.

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1588981542 NPI number is provided on an as is basis without warranty of any kind. 1588981542 is maintained by the National Plan & Provider Enumeration System. The contents of Charles Clark CASAC are for informational purposes only.