MEDICARE: MS. SHARON MARIE CLARK LPC

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	101YP2500X	Professional Counselor	PC011284	PA

General Provider Information

NPI Number	:	1396317103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON MARIE CLARK LPC

Provider Business Mailing Address
First Line	:	651 STATE ROUTE 118
Second Line	:
City	:	SWEET VALLEY
State	:	PA
Zip	:	18656-2039
Country	:	US
Telephone Number	:	570-406-5236
Fax Number	:

Provider Business Practice Location Address
First Line	:	651 STATE ROUTE 118
Second Line	:
City	:	SWEET VALLEY
State	:	PA
Zip	:	18656-2039
Country	:	US
Telephone Number	:	570-406-5236
Fax Number	:

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

Provider Enumeration Date	:	07/12/2021
Last Update Date	:	07/12/2021

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