Individual
MS. SUSAN M CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, MMT
Contact information
Practice address
714 E PARK AVE, LONG BEACH, NY 11561-2605
(516) 431-7972
Mailing address
532 E HARRISON ST, LONG BEACH, NY 11561-2443
(516) 817-5083
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
013274
NY
Other
Enumeration date
03/30/2007
Last updated
07/08/2007
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