Individual
KELLY ANNE CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
AMERICAN TREATMENT NETWORK PHYSICIAN & ASSOCIATES, 1120 TOWNSHIP LINE ROAD, HAVERTOWN, PA 19083
(484) 535-1231
Mailing address
118 MONTROSE AVE APT C, BRYN MAWR, PA 19010-1574
(215) 388-1399
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275189375
—
PA
Enumeration date
06/11/2020
Last updated
06/11/2020
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