Eileen J Clark, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC06221100 Issued in NJ

Practice address

22 Gordon Ave
Lawrenceville, NJ 08648-1033

Phone

(609) 844-0452

Fax

(609) 844-0518

NPI assigned

Dec 8, 2011

Sex

Female

Sole proprietor

Yes

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 FL, NJ2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

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.

• Mindful Lotus Therapy Inc

  • Clinical Social Worker
  • Davie, FL
  • NPI 1871231571
  Medicare reassignment NPD

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

{
    "created_epoch": "1323302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1205104049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6573",
            "city": "LAWRENCEVILLE",
            "state": "NJ",
            "postal_code": "086480573",
            "telephone_number": "609-844-0452",
            "fax_number": "609-844-0518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 GORDON AVE",
            "city": "LAWRENCEVILLE",
            "state": "NJ",
            "postal_code": "086481033",
            "telephone_number": "609-844-0452",
            "fax_number": "609-844-0518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "EILEEN",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-12-08",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC06221100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susie Chung, PH.D.
• Yce Chung, M.D.
• Cindy Lou Hisle LLC (sylenes)
• Kristen Cipparone, O.D.
• Alissa A Clancey, D.C.
• Clear Lake Addiction and Trauma Center LLC
• Clinical Behavioral Health Associates, PC
• Gale Cohen, RD, CDE
• Irene Mazal Cohen, AUD
• Shodeinde Ariyo Coker, M.D.

• Clinical Social Worker in Lawrenceville, NJ
• Providers in Lawrenceville, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; 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.