NPIMap

Organization Active NPI

Kelli Clark Licensed Clinical Social Worker Professional Corporation

Doing business as Kelli Clark, LCSW, PC

  • Clinical Social Worker
  • San Francisco, CA
National Provider Identifier
1376263319
Registry record updated Aug 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
KELLI CLARK LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CORPORATION
Doing business as
Kelli Clark, LCSW, PC
Practice address
3150 18TH St Ste 350
San Francisco, CA 94110-2077
Phone
(415) 562-4156
Fax
(415) 952-9565
NPI assigned
Aug 30, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2022

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

Authorized official

Name
Mr. Julio Lagos, LCSWNPI 1629106141
Title
Operations
Phone
(415) 562-4156

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

3150 18TH St Ste 350
San Francisco, CA 94110-2077

Mailing address

3150 18TH St Ste 350
Mailbox#202
San Francisco, CA 94110-2075
Phone (415) 562-4156

Other names 1

  • Kelli Clark, LCSW, PC Doing business as

National Provider Directory

National Provider Directory

Locations

3150 18th St
Ste 350
San Francisco, CA 94110
Phone (415) 562-4156

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1661817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661817600000",
    "number": "1376263319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3150 18TH ST STE 350",
            "address_2": "MAILBOX#202",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941102075",
            "telephone_number": "415-562-4156",
            "fax_number": "415-952-9565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 18TH ST STE 350",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941102077",
            "telephone_number": "415-562-4156",
            "fax_number": "415-952-9565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLI CLARK LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-30",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A",
        "authorized_official_last_name": "LAGOS",
        "authorized_official_first_name": "JULIO",
        "authorized_official_title_or_position": "OPERATIONS",
        "authorized_official_telephone_number": "415-562-4156",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kelli Clark, LCSW, PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Francisco, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; 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.