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General NPI Number Information
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NPI Number | 1619431632
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Entity Type | Individual
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Provider Name | ALIESHA YVONNE CLARK DSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 45 GRANITE DR
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City | EAST EARL
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State | PA
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Zip | 17519-9487
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Country | US
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Telephone | 717-543-3246
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Fax |
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Provider Business Mailing Address
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Address Line | 848 E MAIN ST STE 800
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City | EPHRATA
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State | PA
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Zip | 17522-2835
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW025027
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License Number State | PA
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