Individual
MR. CLARK TREVOR SOULIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
35 FELTERS RD, BINGHAMTON, NY 13903-2600
(607) 201-1200
(607) 201-1201
Mailing address
2570 ROUTE 9W STE 10, CORNWALL, NY 12518-1370
(845) 220-3100
(845) 534-2940
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
101176
NY
Other
Enumeration date
09/21/2022
Last updated
09/26/2022
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