Individual
CHRISTINA FERLISE-CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSWR
Contact information
Practice address
206 NICHOLS RD, NESCONSET, NY 11767
(631) 585-4855
Mailing address
206 NICHOLS RD, NESCONSET, NY 11767
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
R059523
NY
Other
Enumeration date
04/15/2010
Last updated
04/15/2010
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