| Doctor Name: | MS. HEATHER AMY CLARK |
| NPI Number: | 1043251259 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA |
| License Number: | 000547-1 |
| Business Practice Address: | 1555 Sunrise Hwy Bay Shore, NY - 117066027 |
| Business Phone Number: | 6316661615 |
| Business Fax Number: | 6316661709 |
| Mailing Address: | 59 Threepence Dr, MELVILLE |
| State: | NY |
| Postal Code: | 117474024 |
| Phone Number: | 5168523265 |
| Fax Number: | 6316661709 |
| NPI Enumeration Date: | 06/09/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 000547-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |