Brianna Lyn Clark, LCSW

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

620 Washington Ave
Rensselaer, NY 12144-1300

Phone

(518) 272-7073

NPI assigned

Feb 2, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 6, 2022 through Oct 6, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brianna Clark, LCSW, PLLC

  • Clinical Social Worker
  • Albany, NY
  • NPI 1073483053
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664841600000",
    "number": "1124527387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 TRILLIUM LN STE 6",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122033818",
            "telephone_number": "860-884-1036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 WASHINGTON AVE",
            "city": "RENSSELAER",
            "state": "NY",
            "postal_code": "121441300",
            "telephone_number": "518-272-7073"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Trillium Ln Ste 6",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122033818",
            "country_code": "US",
            "telephone_number": "860-884-1036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BRIANNA",
        "middle_name": "LYN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-02",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "092224",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janice Bonesteel Catel, LMT
• Catholic Charities Tri-County Services
• Kathleen Catone
• Chirocare, PC
• Dennis B Cicchino, PA
• Michael David Cohen, MD
• Adrian Coleman
• Nancy A. Collins, M.S. ED.
• Community Care Physicians, PC
• Concept Fund Management Org

• Student in an Organized Health Care Education/Training Program in Rensselaer, NY
• Providers in Rensselaer, NY by specialty
• Student in an Organized Health Care Education/Training Program in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.