Rebecca Clark, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW017348 Issued in PA

Practice address

2910 State St
Erie, PA 16508-1832

Phone

(814) 454-5686

Fax

(814) 454-8946

NPI assigned

Oct 24, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Northwest Beacon Group LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Erie, PA
  • NPI 1689695868
  NPD (past)

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632096000000",
    "number": "1174606776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2185 W 8TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165054747",
            "telephone_number": "814-878-3433",
            "fax_number": "814-878-3488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2910 STATE ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165081832",
            "telephone_number": "814-454-5686",
            "fax_number": "814-454-8946"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2185 W 8th St",
            "address_purpose": "LOCATION",
            "city": "Erie",
            "state": "PA",
            "postal_code": "165054747",
            "country_code": "US",
            "telephone_number": "814-878-3433",
            "fax_number": "814-878-3448",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "REBECCA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW017348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elaina Marie Clark, CRNP
• Eric Clark
• Garrett Clark, D.O.
• Geralynn Mary Clark
• Mindy M Clark, CNM
• Zachary Clark
• Maurice Orlando Clarke, LPC
• Clear Blue Holdings, Inc.
• Clearview Psychiatry PLLC
• Karen Marie Cleary-Herman

• Clinical Social Worker in Erie, PA
• Providers in Erie, PA by specialty
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.