| Marianne Clark Psyd Llc | |
|
3804 Church Rd Mount Laurel NJ 08054-1106 | |
| (862) 219-1125 | |
| Not Available |
| Full Name | Marianne Clark Psyd Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3804 Church Rd, Mount Laurel, New Jersey |
| Authorized Official Name and Position | Marianne Clark (PSYCHOLOGIST) |
| Authorized Official Contact | 8622191125 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Marianne Clark Psyd Llc 3804 Church Rd Mount Laurel NJ 08054-1106 Ph: () - | Marianne Clark Psyd Llc 3804 Church Rd Mount Laurel NJ 08054-1106 Ph: (862) 219-1125 |
| NPI Number | 1063057610 |
|---|---|
| Provider Enumeration Date | 11/07/2019 |
| Last Update Date | 11/07/2019 |
| Medicare PECOS PAC ID | 3173996899 |
|---|---|
| Medicare Enrollment ID | O20230228002406 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063057610 | NPI | - | NPPES |
| 77819307 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Marianne Clark |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235109299 PECOS PAC ID: 5395088744 Enrollment ID: I20190528001781 |
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