Provider Demographics
NPI:1447485024
Name:CLARKE, TERRANCE JEROME (MT)
Entity type:Individual
Prefix:MR
First Name:TERRANCE
Middle Name:JEROME
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 MEETINGHOUSE RD
Mailing Address - Street 2:M-2
Mailing Address - City:UPPER CHICHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19061-2947
Mailing Address - Country:US
Mailing Address - Phone:302-438-8162
Mailing Address - Fax:
Practice Address - Street 1:3131 MEETINGHOUSE RD
Practice Address - Street 2:M-2
Practice Address - City:UPPER CHICHESTER
Practice Address - State:PA
Practice Address - Zip Code:19061-2947
Practice Address - Country:US
Practice Address - Phone:302-438-8162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health