Provider Demographics
NPI:1548513880
Name:CLARKE, KRISTIN DAY (PSYD, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:DAY
Last Name:CLARKE
Suffix:
Gender:F
Credentials:PSYD, BCBA-D
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 SHERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-2239
Mailing Address - Country:US
Mailing Address - Phone:321-917-0490
Mailing Address - Fax:
Practice Address - Street 1:36 SHERWOOD LN
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-2239
Practice Address - Country:US
Practice Address - Phone:321-917-0490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-12439103K00000X
IN20043490B103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst