Clark, Fawn M.
Clark, Fawn M. is an individual health care provider with primary practice located at 3 Kensington Square Suite B, New Kensington PA 15068. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Clark, Fawn M. can be contacted via phone (724) 335-9733.Contact Information
Primary practice address
3 Kensington Square Suite B
New Kensington PA 15068
Phone: (724) 335-9733
Fax: (724) 335-9734
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | Pennsylvania | |
Behavioral Health & Social Service Providers / Marriage & Family Therapist | 106H00000X | Pennsylvania |
Profile Details
NPI number | 1205159779 |
---|---|
LBN Legal business name | Clark, Fawn M. |
Credentials | |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Mar 11th, 2010 |
Last updated | Mar 11th, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1205159779 | NPPES |
Pennsylvania | MEDICAID | 1007624160014 | |
Pennsylvania | Other | 330989 | |
Pennsylvania | Other | 184265 | |
Pennsylvania | Other | 424947 | |
Pennsylvania | Other | 7109257 | |
Pennsylvania | Other | 206234 | |
Pennsylvania | Other | 1000364 | |
Pennsylvania | Other | 2595457 |
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