Genese Calloway Clark
Individual provider Active NPI Case Manager/Care Coordinator · New Haven, CT
NPI 1124668694 · NPPES record last updated Jan 13, 2020
Key facts
- NPI
- 1124668694
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Case Manager/Care Coordinator 171M00000X
- Practice address
- 458 Grand Ave Ste 103
New Haven, CT 06513-3873 - Phone
- (203) 850-4737
- NPI assigned
- Jan 13, 2020
- 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
Interoperability endpoints
- genese.clark.p1@direct.wheelerclinic.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Case Manager/Care Coordinator | 171M00000X | Yes |
Addresses
Primary practice location
458 Grand Ave Ste 103
New Haven, CT 06513-3873
Mailing address
458 Grand Ave Ste 103
New Haven, CT 06513-3873
Other providers in New Haven, CT
- Claire Isenga Nutrition LLC
- Leslie Clapp
- Augusto Clari
- Brian Joseph Clark
- Corinna Augusta Clark
- Helena Jeanette Clark
- Katherine Arlene Arner Clark
- Mitchell Brent Clark
- Terri Patrice Clark
- Vashti Clark
All providers in New Haven, CT · Case Manager/Care Coordinator 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 13, 2020. 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.