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General NPI Number Information
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NPI Number | 1548513880
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Entity Type | Individual
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Provider Name | KRISTIN DAY CLARKE PSY.D., BCBA-D
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Gender | Female
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Dates
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Enumeration Date | 10/24/2012
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 36 SHERWOOD LN
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City | LAKEVILLE
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State | MA
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Zip | 02347-2239
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Country | US
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Telephone | 321-917-0490
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Fax |
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Provider Business Mailing Address
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Address Line | 36 SHERWOOD LN
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City | LAKEVILLE
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State | MA
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Zip | 02347-2239
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Country | US
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Telephone | 321-917-0490
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-12-12439
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20043490B
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License Number State | IN
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