Individual
DR. DEBRA E CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
110 N CAYUGA ST, ITHACA, NY 14850-4326
(607) 273-1038
Mailing address
110 N CAYUGA ST, ITHACA, NY 14850-4326
(607) 273-1038
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
011479
NY
Other
Enumeration date
05/06/2010
Last updated
05/06/2010
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