Provider Demographics
NPI:1174665681
Name:CLARK INSTITUTE
Entity type:Organization
Organization Name:CLARK INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, FAPA
Authorized Official - Phone:732-431-1514
Mailing Address - Street 1:3303 APPLEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4922
Mailing Address - Country:US
Mailing Address - Phone:732-431-1514
Mailing Address - Fax:609-395-0120
Practice Address - Street 1:3303 APPLEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-4922
Practice Address - Country:US
Practice Address - Phone:732-431-1514
Practice Address - Fax:609-395-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182788103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
106486OtherAPSA
1706OtherAPH
83704OtherNAAP
999012391OtherACH