Teresa Coral-Clark, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

119305 Issued in MA

Practice address

137 Lotus Ave
San Antonio, TX 78210-1621

Phone

(210) 213-3660

NPI assigned

Oct 14, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1476403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1376094326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 LIBERTY SQUARE",
            "address_2": "PMB 94217",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021091621",
            "telephone_number": "210-776-1724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "137 LOTUS AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782101621",
            "telephone_number": "210-213-3660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORAL-CLARK",
        "first_name": "TERESA",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-14",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "37960",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "119305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Coppock, PSY.D.
• John V Coppola, DC
• Kevin Coppola, DDS
• William T. Coppola, DDS.
• Jonette Suzanne Coquat, LCSW, LADC
• Corales Dental Office
• Corazon del Valle DME LLC
• Anthony J Corbet
• John Corbett, DMD
• Ojer Corbie

• Clinical Social Worker in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; 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.