Arthur J. Clark, ED.D.
Individual provider Active NPI Psychologist · Canton, NY
NPI 1194874446 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1194874446
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 2575 (MA)
- Practice address
- 16 College St
Canton, NY 13617-1408 - Phone
- (315) 386-8584
- Fax
- (315) 229-7423
- NPI assigned
- Jan 9, 2007
- Sex
- Male
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2575 | MA | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2575 | MA | Yes |
Addresses
Primary practice location
16 College St
Canton, NY 13617-1408
Mailing address
16 College St
Canton, NY 13617-1408
Phone (315) 386-8584
Other providers in Canton, NY
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.