Amber Teresa Clark, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149014123 Issued in IL

Practice address

3035 E Mound Rd
Decatur, IL 62526-9650

Phone

(217) 554-3000

Fax

(217) 875-2689

NPI assigned

Dec 21, 2009

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

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

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 and National Provider Directory roles.

• Veteran's Administration

  • Federally Qualified Health Center (FQHC)
  • Decatur, IL
  • NPI 1043323793
  NPD (past)

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

{
    "created_epoch": "1261353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364947200000",
    "number": "1366771339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3035 E MOUND RD",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625269650",
            "telephone_number": "217-554-3000",
            "fax_number": "217-875-2689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3035 E MOUND RD",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625269650",
            "telephone_number": "217-554-3000",
            "fax_number": "217-875-2689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "AMBER",
        "middle_name": "TERESA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-21",
        "last_updated": "2013-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149014123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Paul Christy II
• Larisa Georgy Ciatlos-Deak, MD
• Breanne Joleen Clair, MS, CCC-SLP
• Clark Enterprises 407 LLC (Comfort Keepers)
• Clark Enterprises 407 LLC (Comfort Keepers)
• Hailee Clark
• Kelly Clark, DDS
• Ben Clawson, ATC, CSCS
• Shelbi Clay, LPN
• Lilian Kay Clayton, CNM

• Clinical Social Worker in Decatur, IL
• Providers in Decatur, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.