Judith Z Clark, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY13963 Issued in CA

Practice address

126 Old Mammoth Rd
Suite 214
Mammoth Lakes, CA 93546

Phone

(760) 924-8503

Fax

(760) 924-0541

NPI assigned

Sep 21, 2006

Last updated

Sep 20, 2011By the provider in NPPES

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316476800000",
    "number": "1356440275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO 100 PMB 470",
            "city": "MAMMOTH LAKES",
            "state": "CA",
            "postal_code": "935460100",
            "telephone_number": "760-924-8503",
            "fax_number": "760-924-0541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 OLD MAMMOTH RD",
            "address_2": "SUITE 214",
            "city": "MAMMOTH LAKES",
            "state": "CA",
            "postal_code": "93546",
            "telephone_number": "760-924-8503",
            "fax_number": "760-924-0541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JUDITH",
        "middle_name": "Z",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2011-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY13963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PSY139630",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "11413861",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "CP13963",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cassandra Beatriz Carter
• Lavaree Chavez
• Sara Chavez, PHYSICAL THERAPIST
• Melvin Cherne, MD
• Sabrina Noelle Cimerol, D.M.D
• Peter Clark, M.D.
• Roger L Claypool, M.D.
• Brittania Cogan
• James Albert Cole, RPT
• Kristin Elizabeth Collins, DO

• Clinical Psychologist in Mammoth Lakes, CA
• Providers in Mammoth Lakes, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; 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.