Healthcare Provider Details

I. General information

NPI: 1679840136
Provider Name (Legal Business Name): CLAUDINE KATHERINE CLARKE M. S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT VINCENTS DR
SAN RAFAEL CA
94903-1504
US

IV. Provider business mailing address

801 ZEPHYR DR
OAKLAND CA
94607-1547
US

V. Phone/Fax

Practice location:
  • Phone: 415-507-2000
  • Fax:
Mailing address:
  • Phone: 415-735-8210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.006896
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: