Individual
MARCIA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC
Contact information
Practice address
1062 STATE ROUTE 38, OWEGO, NY 13827-3209
(607) 687-4000
(607) 687-6396
Mailing address
1062 STATE ROUTE 38, PO BOX 177, OWEGO, NY 13827-3209
(607) 687-4000
(607) 687-6396
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18570
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00618162
GROUP MEDICAID NUMBER
NY
Enumeration date
04/16/2008
Last updated
04/16/2008
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