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General NPI Number Information
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NPI Number | 1104180546
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Entity Type | Individual
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Provider Name | VICTORIA CAROL CLARK M.S. SPECIAL ED
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Gender | Female
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Dates
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Enumeration Date | 06/29/2012
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 155 PHILLIPS HILL RD
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City | NEW CITY
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State | NY
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Zip | 10956-4129
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Country | US
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Telephone | 845-708-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 114 SNEDECKER AVE
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City | CONGERS
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State | NY
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Zip | 10920-1808
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Country | US
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Telephone | 845-268-0316
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1199846
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License Number State | NY
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