Individual
CARLY ANN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T
Contact information
Practice address
127 W 79TH ST, SUITE 4, NEW YORK, NY 10024-6416
(607) 316-7918
Mailing address
1164 PACIFIC ST, APT B1, BROOKLYN, NY 11216-2944
(607) 316-7918
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
022370
NY
Other
Enumeration date
02/12/2009
Last updated
02/12/2009
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