Mariella E Clark, LCSW
Individual provider Active NPI Clinical Social Worker · Lakeside, TX
NPI 1245798156 · NPPES record last updated Dec 15, 2019
Key facts
- NPI
- 1245798156
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 57729 (TX)
- Practice address
- 121 Oakwood CT
Lakeside, TX 76135-4932 - Phone
- (817) 779-0850
- NPI assigned
- Mar 10, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2024 through Jul 1, 2028
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Let It Rain Psychotherapy, PLLC | Clinical | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | 57729 | TX | Yes |
Addresses
Primary practice location
121 Oakwood CT
Lakeside, TX 76135-4932
Mailing address
121 Oakwood CT
Lakeside, TX 76135-4932
Phone (817) 779-0850
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mclark@sbsproactive.com | Direct |
Other providers in Lakeside, TX
- Kathi Edmonson
- Kimberli Paige Edmonson
- Noble U. Ezukanma
- Mainstream Habilitation Services of Texas, Inc.
- Chase C McKinney
All providers in Lakeside, TX · Clinical Social Worker in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.