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NPI Code Detail

MEDICARE: MARIANNE CLARK PSY.D.

MEDICARE: MARIANNE CLARK PSY.D.
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
1103TC0700XClinical PsychologistSI00357800NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235109299
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIANNE CLARK PSY.D.
Provider Business Mailing Address
First Line : 3804 CHURCH RD
Second Line :
City : MOUNT LAUREL
State : NJ
Zip : 08054-1106
Country : US
Telephone Number : 862-219-1125
Fax Number :
Provider Business Practice Location Address
First Line : 3804 CHURCH RD
Second Line :
City : MOUNT LAUREL
State : NJ
Zip : 08054-1106
Country : US
Telephone Number : 862-219-1125
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2006
Last Update Date : 10/24/2019

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