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Individual
LESLIE CLARKE
Active
Individual
LESLIE CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-C
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
BH000071
PA
1041C0700X
Clinical Social Worker
Primary
20639
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1770529869
MEDICARE
MD
Enumeration date
03/04/2014
Last updated
09/15/2020
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