Eleanor Ann Clark II, BA, CADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

37CA00065700 Issued in NJ

Practice address

84 Main St
Hackensack, NJ 07601-7143

Phone

(201) 471-5694

NPI assigned

Jul 15, 2021

Sex

Female

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)

Not enrolled

Credentials

Bachelor of Arts

State licenses

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

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626307200000",
    "number": "1316519655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "84 MAIN ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076017143",
            "telephone_number": "201-471-5694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 MAIN ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076017143",
            "telephone_number": "201-471-5694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ELEANOR",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "name_suffix": "II",
        "credential": "BA, CADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-15",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "37CA00065700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0183385",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Lisa Cioffi, LSW
• Bernard C Ciongoli, D.O.
• City of Hackensack
• City of Hackensack Fire Department
• Elizabeth Clanaman
• Sharonda Nicole Clark, MD
• Nadine Clarke-Bailey
• Praeophayom Clarke, MD
• Briana Joy Clauss, DC
• Katharine N Clouser, M.D.

• Addiction (Substance Use Disorder) Counselor in Hackensack, NJ
• Providers in Hackensack, NJ by specialty
• Addiction (Substance Use Disorder) Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; 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.