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General NPI Number Information
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NPI Number | 1174665681
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Entity Type | Organization
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Legal Business Name | CLARK INSTITUTE
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 10/09/2018
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Provider Practice Location Address
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Address Line | 3303 APPLEWOOD DRIVE
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City | FREEHOLD
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State | NJ
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Zip | 07728-4922
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Country | US
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Telephone | 732-431-1514
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Fax | 609-395-0120
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Provider Business Mailing Address
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Address Line | 3303 APPLEWOOD DRIVE
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City | FREEHOLD
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State | NJ
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Zip | 07728-4922
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Country | US
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Telephone | 732-431-1514
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Fax | 609-395-0120
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Authorized Official
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Title or Position | PRESIDENT
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Name | BARBARA J CLARK
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Credential | PHD, FAPA
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Telephone | 732-431-1514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 182788
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License Number State | NY
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