Patrick Jeremiah Clark, MSW – Clinical Social Worker

Key facts

NPI: 1235313388
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Social Worker 1041C0700X
License: 16872LICSW (MN)
Practice address: 540 E First St
Waconia, MN 55387-1601
Phone: (952) 442-4437
Fax: (952) 442-3084
NPI assigned: Dec 26, 2007
Sex: Male
Sole proprietor: No

Organizations & group practices 1

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.

Carver County Mental Health Clinic/Center (Including Community Mental Health Center) · Waconia, MN · NPI 1326049685

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
16872LICSW	MN	MD	Clinical Social Worker

Practice roles

Organization	Specialty	Status	New patients
Carver County		Past since May 16, 2000	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinical Social Worker	1041C0700X	16872LICSW	MN	Yes

Addresses

Primary practice location

540 E First St
Waconia, MN 55387-1601

Mailing address

540 E First St
Waconia, MN 55387-1601
Phone (952) 442-4437

Other identifiers

Identifier	Type	State	Issuer
HP84895	Other	MN	HEALTH PARTNERS

Other providers in Waconia, MN

All providers in Waconia, MN · Clinical Social Worker in Minnesota

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 26, 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.

Verify at the official NPI Registry.