Active NPI
Jacalyn Clark, LPC
- Mental Health Counselor
- Southport, CT
National Provider Identifier
1093673121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 9373
- Practice address
- 255 Half Mile Rd
Southport, CT 06890-1017 - Phone
- (385) 290-5014
- NPI assigned
- Jan 15, 2026
- Last updated
- Jan 15, 2026
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 9373 | CT | Primary |
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
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 |
|---|---|---|---|
| 9373 | CT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1768435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1768435200000",
"number": "1093673121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "255 HALF MILE RD",
"city": "SOUTHPORT",
"state": "CT",
"postal_code": "068901017",
"telephone_number": "385-290-5014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 HALF MILE RD",
"city": "SOUTHPORT",
"state": "CT",
"postal_code": "068901017",
"telephone_number": "385-290-5014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JACALYN",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-01-15",
"last_updated": "2026-01-15",
"certification_date": "2026-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CT",
"license": "9373",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southport, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.