Jacalyn Clark, LPC
Individual provider Active NPI Mental Health Counselor · Southport, CT
NPI 1093673121 · NPPES record last updated Jan 15, 2026
Key facts
- NPI
- 1093673121
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 9373 (CT)
- Practice address
- 255 Half Mile Rd
Southport, CT 06890-1017 - Phone
- (385) 290-5014
- NPI assigned
- Jan 15, 2026
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9373 | CT | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 9373 | CT | Yes |
Addresses
Primary practice location
255 Half Mile Rd
Southport, CT 06890-1017
Mailing address
255 Half Mile Rd
Southport, CT 06890-1017
Phone (385) 290-5014
Other providers in Southport, CT
- Maria Vittoria Carnevale
- Michelle Caserta
- Stacey L Casparius
- Bradford Stephen Chervin
- Noah Stephen Citsay
- Coastal Connecticut Counseling LLC
- Robert Ralph Cohen
- Connecticut Plastic Surgery Group, LLC
- Cortex Health PLLC
- Cpdental, PLLC
All providers in Southport, CT · Mental Health Counselor in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.