Individual
MR. RALPH M CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
110 MAIN ST, MINEOLA, NY 11501-4000
(516) 747-5644
(516) 747-2556
Mailing address
110 MAIN ST, MINEOLA, NY 11501-4000
(516) 747-5644
(516) 747-2556
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3827
NY
Other
Enumeration date
01/21/2014
Last updated
01/21/2014
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