Active NPI
Aileen Clark, PH.D.
- Psychologist
- New York, NY
National Provider Identifier
1003086760
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 012551
- Practice address
- 250 West St
Suite 11F
New York, NY 10013 - Phone
- (917) 815-9616
- NPI assigned
- Mar 8, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 012551 | NY | Primary |
Addresses
Primary practice location
250 West St
Suite 11F
New York, NY 10013
Mailing address
250 West St
Suite 11F
New York, NY 10013
Phone (917) 815-9616
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012551 | NY | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726704000000",
"number": "1003086760",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 WEST ST",
"address_2": "SUITE 11F",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10013",
"telephone_number": "917-815-9616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 WEST ST",
"address_2": "SUITE 11F",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10013",
"telephone_number": "917-815-9616"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "AILEEN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-03-08",
"last_updated": "2024-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "012551",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.