Active NPI
Wayne E Clark, CASAC
- Addiction (Substance Use Disorder) Counselor
- Bronx, NY
National Provider Identifier
1396209136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 23387
- Practice address
- 820 Saint Anns Ave
Bronx, NY 10456-7885 - Phone
- (646) 316-3265
- NPI assigned
- Jan 25, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 23387 | NY | Primary |
Addresses
Primary practice location
820 Saint Anns Ave
Bronx, NY 10456-7885
Mailing address
2012 Benedict Ave Ste 2
Bronx, NY 10462-4404
Phone (646) 316-3265
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23387 | NY | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548374400000",
"number": "1396209136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2012 BENEDICT AVE STE 2",
"city": "BRONX",
"state": "NY",
"postal_code": "104624404",
"telephone_number": "646-316-3265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 SAINT ANNS AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104567885",
"telephone_number": "646-316-3265"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "WAYNE",
"middle_name": "E",
"credential": "CASAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-01-25",
"last_updated": "2019-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NY",
"license": "23387",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.