Provider Demographics
NPI:1508962408
Name:CLARK, JOHANNA DANIELA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:DANIELA
Last Name:CLARK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 STOKES AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-3307
Mailing Address - Country:US
Mailing Address - Phone:856-617-1896
Mailing Address - Fax:
Practice Address - Street 1:1107 STOKES AVE
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-3307
Practice Address - Country:US
Practice Address - Phone:856-617-1896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0935471041C0700X
PACW0154311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical