Provider Demographics
NPI:1447935267
Name:CLARK, NOELLE (LICENSED SPED ED)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:LICENSED SPED ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MARYTON RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-2000
Mailing Address - Country:US
Mailing Address - Phone:914-438-4450
Mailing Address - Fax:
Practice Address - Street 1:120 MARYTON RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-2000
Practice Address - Country:US
Practice Address - Phone:914-438-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator