| Randy Clark Lpc Llc | |
|
209 Cooper Avenue Suite 2 Upper Montclair NJ 07043-1850 | |
| (973) 220-9864 | |
| (973) 807-9363 |
| Full Name | Randy Clark Lpc Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 209 Cooper Avenue, Upper Montclair, New Jersey |
| Authorized Official Name and Position | William Randall Clark (OWNER) |
| Authorized Official Contact | 9732209864 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Randy Clark Lpc Llc 209 Cooper Avenue Suite 2 Upper Montclair NJ 07043-1850 Ph: (973) 220-9864 | Randy Clark Lpc Llc 209 Cooper Avenue Suite 2 Upper Montclair NJ 07043-1850 Ph: (973) 220-9864 |
| NPI Number | 1932577459 |
|---|---|
| Provider Enumeration Date | 09/15/2015 |
| Last Update Date | 08/19/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932577459 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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