Clark, Judith J

Clark, Judith J is an individual health care provider with primary practice located at 239 S Butler Rd , Lebanon PA 17042-8939. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Clark, Judith J can be contacted via phone (717) 273-8871.

Contact Information

Primary practice address
239 S Butler Rd Lebanon PA 17042-8939
Phone: (717) 273-8871
Fax: (717) 270-2452
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X PC000691 Pennsylvania

Profile Details

NPI number 1346421658
LBN Legal business name Clark, Judith J
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 15th, 2007
Last updated Feb 1st, 2023 - about last year

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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346421658 NPPES
Pennsylvania Other PC000691 STATE LICENSE - PC
Pennsylvania MEDICAID 103757394 STATE LICENSE - PC
Pennsylvania Other 11836138 STATE LICENSE - PC

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