Individual
BASHAWN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
463 FASHION AVE FL 18, NEW YORK, NY 10018-7760
(914) 426-0517
Mailing address
463 FASHION AVE FL 18, NEW YORK, NY 10018-7760
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
115116
NY
Other
Enumeration date
07/09/2024
Last updated
07/09/2024
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