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NPI Code Detail

MEDICARE: DR. DIAON M CLARKE LCSW-R

MEDICARE: DR. DIAON M CLARKE LCSW-R
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
11041C0700XClinical Social Worker080420NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11285628552OTHERNYAGENCY
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164758009
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIAON M CLARKE LCSW-R
Provider Business Mailing Address
First Line : 6 GRAMATAN AVE STE 607
Second Line :
City : MOUNT VERNON
State : NY
Zip : 10550-3208
Country : US
Telephone Number : 917-604-6438
Fax Number :
Provider Business Practice Location Address
First Line : 6 GRAMATAN AVE STE 607
Second Line :
City : MOUNT VERNON
State : NY
Zip : 10550-3208
Country : US
Telephone Number : 914-837-8336
Fax Number : 914-560-2135
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2009
Last Update Date : 02/18/2020

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