Healthcare Provider Details

I. General information

NPI: 1255570602
Provider Name (Legal Business Name): CONNECTED PATH CLINICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 TRAVERTINE WAY
NEWARK DE
19702-2402
US

IV. Provider business mailing address

3 TRAVERTINE WAY
NEWARK DE
19702-2402
US

V. Phone/Fax

Practice location:
  • Phone: 302-241-5961
  • Fax:
Mailing address:
  • Phone: 302-241-5961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number01-03-1130
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number01-0001086
License Number StateDE

VIII. Authorized Official

Name: MR. TODD D. CLARKE
Title or Position: CHIEF FINANCIAL OFFICER
Credential: MBA
Phone: 443-566-0813