| Doctor Name: | AMY M CLARK |
| NPI Number: | 1497056311 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | CW018061 |
| Business Practice Address: | 130 Bridge St Tunkhannock, PA - 186571354 |
| Business Phone Number: | 5705752468 |
| Business Fax Number: | 5708360660 |
| Mailing Address: | 130 Bridge St, TUNKHANNOCK |
| State: | PA |
| Postal Code: | 186571354 |
| Phone Number: | 5705752468 |
| Fax Number: | 5708360660 |
| NPI Enumeration Date: | 11/09/2010 |
| NPI Last Update Date: | 04/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | CW018061 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |