Individual
GEORGETTE MARIA CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1042 E 102ND ST, BROOKLYN, NY 11236-4420
(646) 483-7828
Mailing address
1042 E 102ND ST, BROOKLYN, NY 11236-4420
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
121716021
NY
252Y00000X
Early Intervention Provider Agency
Primary
216775031
NY
Other
Enumeration date
12/31/2018
Last updated
12/31/2018
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