Individual
EMILY RAE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10819 ROCKAWAY BLVD, SOUTH OZONE PARK, NY 11420-1034
(718) 845-2620
Mailing address
6835 BURNS ST APT D2, FOREST HILLS, NY 11375-5086
(414) 897-4113
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
01/26/2022
Last updated
01/26/2022
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