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General NPI Number Information
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NPI Number | 1679605117
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Entity Type | Individual
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Provider Name | ROBERT ALLEN CLARK PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 COOPER MORRIS DR
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City | POMONA
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State | NY
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Zip | 10970-3309
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Country | US
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Telephone | 845-354-0233
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Fax |
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Provider Business Mailing Address
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Address Line | 535 W 217TH ST
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City | NEW YORK
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State | NY
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Zip | 10034-1302
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Country | US
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Telephone | 212-567-4738
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Fax | 212-567-4738
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 005568-1
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License Number State | NY
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