Mary Melissa Ar Clark-White, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

100783 Issued in CA

Practice address

2200 Monroe St Apt 1818
Santa Clara, CA 95050-3466

Phone

(510) 846-9264

NPI assigned

Apr 22, 2022

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

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Clinical

  Medicare reassignment NPD

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

{
    "created_epoch": "1650585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650585600000",
    "number": "1184368516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 MONROE ST APT 1818",
            "city": "SANTA CLARA",
            "state": "CA",
            "postal_code": "950503466",
            "telephone_number": "510-846-9264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 MONROE ST APT 1818",
            "city": "SANTA CLARA",
            "state": "CA",
            "postal_code": "950503466",
            "telephone_number": "510-846-9264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK-WHITE",
        "first_name": "MARY MELISSA",
        "middle_name": "AR",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-22",
        "last_updated": "2022-04-22",
        "certification_date": "2022-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "100783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Kai-Wong Chung, D.O
• Travis Chung, PHARM. D.
• City of Santa Clara (City of Santa Clara Fire Department)
• CL Recovery Center
• Dona J Clair, LMFT
• Brianna Clark
• Craig William Clark, CRAIG CLARK, MFT
• Zoe R Clark, MSW
• David Clarke, MD
• James Lincoln Clarke Jr., LMFT

• Clinical Social Worker in Santa Clara, CA
• Providers in Santa Clara, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2022; 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.