Individual
KIMBERLY CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
85 LOTUS OVAL S, VALLEY STREAM, NY 11581-2331
(631) 796-8348
Mailing address
85 LOTUS OVAL S, VALLEY STREAM, NY 11581-2331
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
11/08/2021
Last updated
11/08/2021
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