Sandra Ann Clark, MSW
Individual provider Active NPI Clinical Social Worker · Kittery, ME
NPI 1104862341 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1104862341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LC3768 (ME)
- Practice address
- 25 Old Ferry LN
Kittery, ME 03904-1305 - Phone
- (207) 439-5149
- Fax
- (207) 439-6001
- NPI assigned
- Jun 22, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LICSW1017961 | MA | MD | Clinical Social Worker |
| LC3768 | ME | MD | Clinical Social Worker |
| LICSW298 | NH | MD | Clinical Social Worker |
| 1017961 | MA | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cornerstone Behavioral Healthcare, LLC | Past | Accepting new patients | |
| Seacoast Counseling of Newburyport | Clinical | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LC3768 | ME | Yes |
| Clinical Social Worker | 1041C0700X | LICSW298 | NH | |
| Clinical Social Worker | 1041C0700X | LICSW1017961 | MA |
Addresses
Primary practice location
25 Old Ferry LN
Kittery, ME 03904-1305
Mailing address
25 Old Ferry LN
Kittery, ME 03904-1305
Phone (207) 439-5149
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0024738 | Medicaid | MA | |
| 30420808 | Medicaid | NH |
Other providers in Kittery, ME
- Mark P Cartier
- Donna Labrie Catalfo
- Ryan Erik Chessie
- Margaret Julia Childress
- Christian Counseling Associates, LLC
- Alyssa Jean Cole
- Conant Associates LLC
- Beverly Anne Conant
- Richard H Conant
- Richard T. Connelly
All providers in Kittery, ME · Clinical Social Worker in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.