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NPI Code Detail

MEDICARE: RITA CLARK LCSW

MEDICARE: RITA CLARK LCSW
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 WorkerSW5134FL

General Provider Information

NPI Number : 1396936878
Entity Type Code : Individual
Provider Name (Legal Business Name) : RITA CLARK LCSW
Provider Business Mailing Address
First Line : 3349 N UNIVERSITY DR
Second Line : SUITE 4
City : HOLLYWOOD
State : FL
Zip : 33024-9000
Country : US
Telephone Number : 954-885-9500
Fax Number : 954-885-9444
Provider Business Practice Location Address
First Line : 3349 N UNIVERSITY DR
Second Line : SUITE 4
City : HOLLYWOOD
State : FL
Zip : 33024-9000
Country : US
Telephone Number : 954-885-9500
Fax Number : 954-885-9444
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2007
Last Update Date : 08/08/2007

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Directions to “ RITA CLARK LCSW” Practice Location

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