1588801195 NPI number — DR. ANNEMARIE FRANCES CLARKE PH.D.

Table of content: DR. ANNEMARIE FRANCES CLARKE PH.D. (NPI 1588801195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588801195 NPI number — DR. ANNEMARIE FRANCES CLARKE PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLARKE
Provider First Name:
ANNEMARIE
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588801195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10521 DRUMMOND ROAD
Provider Second Line Business Mailing Address:
SPIN BEHAVIORAL & DEVELOPMENTAL SERVICES DEPARTMENT
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-612-7575
Provider Business Mailing Address Fax Number:
215-632-6426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10521 DRUMMOND RD
Provider Second Line Business Practice Location Address:
SPIN BEHAVIORAL & DEVELOPMENTAL SERVICES DEPARTMENT
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19154-3807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-612-7575
Provider Business Practice Location Address Fax Number:
215-632-6426
Provider Enumeration Date:
01/20/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PS016576 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)