Provider Demographics
NPI:1598420036
Name:CLARKE, NATOYA A
Entity type:Individual
Prefix:
First Name:NATOYA
Middle Name:A
Last Name:CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 BRONX RIVER RD APT B23
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-7905
Mailing Address - Country:US
Mailing Address - Phone:914-316-8174
Mailing Address - Fax:
Practice Address - Street 1:1 EXECUTIVE BLVD STE 178
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-6836
Practice Address - Country:US
Practice Address - Phone:914-595-1482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-31
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0893381104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty