Provider Demographics
NPI:1972368355
Name:CLARKE NEWLIN PRACTICE, LLC
Entity type:Organization
Organization Name:CLARKE NEWLIN PRACTICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:W
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:937-952-5009
Mailing Address - Street 1:5335 FAR HILLS AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2317
Mailing Address - Country:US
Mailing Address - Phone:937-952-5009
Mailing Address - Fax:937-952-5026
Practice Address - Street 1:5335 FAR HILLS AVE STE 109
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2317
Practice Address - Country:US
Practice Address - Phone:937-952-5009
Practice Address - Fax:937-952-5026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty