Provider Demographics
NPI:1316086259
Name:CLARK, ELIZABETH M (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:CLARK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NOYES ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-3852
Mailing Address - Country:US
Mailing Address - Phone:315-738-4023
Mailing Address - Fax:315-738-4403
Practice Address - Street 1:1400 NOYES ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3852
Practice Address - Country:US
Practice Address - Phone:315-738-4023
Practice Address - Fax:315-738-4403
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker