Individual
FAWN M. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3 KENSINGTON SQUARE, SUITE B, NEW KENSINGTON, PA 15068
(724) 335-9733
(724) 335-9734
Mailing address
3 KENSINGTON SQUARE, SUITE B, NEW KENSINGTON, PA 15068
(724) 335-9733
(724) 335-9734
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
PA
106H00000X
Marriage & Family Therapist
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1000364
COMMUNITY BEHAVIORAL HEALTH ORGANIZATION
PA
05
—
1007624160014
—
PA
01
—
184265
UNISON
PA
01
—
206234
UPMC
PA
01
—
2595457
AETNA
PA
01
—
330989
VALUE BEHAVIORAL HEALTH
PA
01
—
424947
HEALTH AMERICA
PA
01
—
7109257
AETNA
PA
Enumeration date
03/11/2010
Last updated
03/11/2010
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