Individual
DR. DERRICK J CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1663 DOMINICAN WAY, STE 214, SANTA CRUZ, CA 95065-1527
(831) 475-3231
(831) 462-4936
Mailing address
1663 DOMINICAN WAY, STE 214, SANTA CRUZ, CA 95065-1527
(831) 475-3231
(831) 462-4936
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY13424
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PSY134241
—
CA
Enumeration date
09/07/2006
Last updated
07/08/2007
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