Active NPI
Thomas Edward Clark, LMFT, LMFT
- Student in an Organized Health Care Education/Training Program
- Albany, NY
National Provider Identifier
1053558205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 56783
- Practice address
- 980 Western Avenue
Albany, NY 12202 - Phone
- (518) 662-0621
- NPI assigned
- Jan 9, 2009
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 56783 | CA | Primary |
Addresses
Primary practice location
980 Western Avenue
Albany, NY 12202
Mailing address
980 Western Avenue
Albany, NY 12202
Phone (518) 662-0621
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 56783 | Other | CA | MFT INTERN NUMBER |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56783 | CA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409875200000",
"number": "1053558205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "980 WESTERN AVENUE",
"city": "ALBANY",
"state": "NY",
"postal_code": "12202",
"telephone_number": "518-662-0621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "980 WESTERN AVENUE",
"city": "ALBANY",
"state": "NY",
"postal_code": "12202",
"telephone_number": "518-662-0621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "THOMAS",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"credential": "LMFT, LMFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-09",
"last_updated": "2014-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CA",
"license": "56783",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MFT INTERN NUMBER",
"identifier": "56783",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albany, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.