Provider Demographics
NPI:1194997486
Name:CLARK, ELLEN B (MED)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:B
Last Name:CLARK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
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Mailing Address - Street 1:4117 LIBERTY AVE
Mailing Address - Street 2:ENTRANCE 3
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1446
Mailing Address - Country:US
Mailing Address - Phone:412-586-2578
Mailing Address - Fax:412-586-2891
Practice Address - Street 1:3501 FORBES AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3317
Practice Address - Country:US
Practice Address - Phone:412-246-5983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)