Provider Demographics
NPI:1366815045
Name:CLARKE, CHERYL ANGELA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANGELA
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 BRIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-4004
Mailing Address - Country:US
Mailing Address - Phone:718-584-1585
Mailing Address - Fax:
Practice Address - Street 1:2660 BRIGGS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4004
Practice Address - Country:US
Practice Address - Phone:718-584-1585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001263106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist