Organization
MARIANNE CLARK PSYD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIANNE CLARK PSYD (PSYCHOLOGIST)
(862) 219-1125
Entity
Organization
Contact information
Practice address
3804 CHURCH RD, MOUNT LAUREL, NJ 08054-1106
(862) 219-1125
Mailing address
3804 CHURCH RD, MOUNT LAUREL, NJ 08054-1106
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77819307
—
NJ
Enumeration date
11/07/2019
Last updated
11/07/2019
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