MEDICARE: TAJAE CLARKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1164378253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAJAE CLARKE

Provider Business Mailing Address
First Line	:	699 EAST 94 STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236
Country	:	US
Telephone Number	:	607-312-8730
Fax Number	:

Provider Business Practice Location Address
First Line	:	699 EAST 94 STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236
Country	:	US
Telephone Number	:	607-312-8730
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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Directions to “ TAJAE CLARKE ” Practice Location

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