Brian K Clark, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1471-123 Issued in WI

Practice address

9200 W Loomis Rd
#103
Franklin, WI 53132

Phone

(414) 425-1250

Fax

(414) 425-1459

NPI assigned

Aug 7, 2006

Last updated

Aug 26, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aurora Psychiatric Hospital, Inc.

  • Psychiatric Hospital
  • Wauwatosa, WI
  • NPI 1881627438
  NPD (past)

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566777600000",
    "number": "1205845336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 W FOREST HOME AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532152843",
            "telephone_number": "414-647-6326",
            "fax_number": "414-671-8860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 W LOOMIS RD",
            "address_2": "#103",
            "city": "FRANKLIN",
            "state": "WI",
            "postal_code": "53132",
            "telephone_number": "414-425-1250",
            "fax_number": "414-425-1459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BRIAN",
        "middle_name": "K",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-07",
        "last_updated": "2019-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "1471-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39235600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael S Cianciolo, MD
• Mary Ellen Cieslak, RN
• City of Franklin
• City of Franklin (Franklin Fire Department)
• Amy Clark, LCSW, SAC
• David J Clark, MD
• Julie Ann Cleary, RN
• Heidi Clement, LCSW, SAC-IT
• Clifden Court Operations LLC
• Clifden Court Operations LLC

• Clinical Social Worker in Franklin, WI
• Providers in Franklin, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.