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General NPI Number Information
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NPI Number | 1366278475
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Entity Type | Individual
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Provider Name | ASHLEY CLARKE CLAYTON MHC-LIMITED PERMIT
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Gender | Female
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Dates
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Enumeration Date | 09/13/2024
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 1946 WEBSTER AVE
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City | BRONX
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State | NY
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Zip | 10457-4249
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Country | US
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Telephone | 212-368-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 1465 NELSON AVE APT 4A
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City | BRONX
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State | NY
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Zip | 10452-1764
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Country | US
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Telephone | 917-587-8637
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 18-P127601-01
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License Number State | NY
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