Provider Demographics
NPI:1528269776
Name:CLARKE, HERMA B (PHD,FACN,CNS,RD)
Entity type:Individual
Prefix:DR
First Name:HERMA
Middle Name:B
Last Name:CLARKE
Suffix:
Gender:F
Credentials:PHD,FACN,CNS,RD
Other - Prefix:MRS
Other - First Name:HERMA
Other - Middle Name:BEATRICE
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD,FACN,CNSRD
Mailing Address - Street 1:31 CHELSEA PL
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1907
Mailing Address - Country:US
Mailing Address - Phone:973-674-3008
Mailing Address - Fax:973-674-3088
Practice Address - Street 1:31 CHELSEA PL
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1907
Practice Address - Country:US
Practice Address - Phone:973-674-3008
Practice Address - Fax:973-674-3088
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL337139133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education