Healthcare Provider Details

I. General information

NPI: 1467316455
Provider Name (Legal Business Name): AMATORITSERO CLARKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CENTRE ST APT 709
QUINCY MA
02169-8600
US

IV. Provider business mailing address

175 CENTRE ST APT 709
QUINCY MA
02169-8600
US

V. Phone/Fax

Practice location:
  • Phone: 347-337-8883
  • Fax:
Mailing address:
  • Phone: 347-337-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: