| Doctor Name: | CONSTANCE AVERY-CLARK |
| NPI Number: | 1033215231 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | PY0003980 |
| Business Practice Address: | 1890 N University Drive Suite 215 Coral Springs, FL - 33071 |
| Business Phone Number: | 9542272700 |
| Business Fax Number: | 9542272704 |
| Mailing Address: | 1890 N University Drive, Suite 215 CORAL SPRINGS |
| State: | FL |
| Postal Code: | 33071 |
| Phone Number: | 9542272700 |
| Fax Number: | 9542272704 |
| NPI Enumeration Date: | 09/15/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PY0003980 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |