Amy Suzanne Clark, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY00002506 Issued in WA

Practice address

4310 Colby Ave Ste 201
Everett, WA 98203-2338

Phone

(425) 252-9216

NPI assigned

Jul 12, 2006

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 1, 2015 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1427083690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12808",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982062808",
            "telephone_number": "425-252-9216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 COLBY AVE STE 201",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982032338",
            "telephone_number": "425-252-9216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "AMY",
        "middle_name": "SUZANNE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY00002506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steve Clancy, PH.D.
• Elisabeth Lorraine Clapper, BA
• Shermoin Rena Clardy, LICSW, SUDPT
• Lynne Marguerite Clark McNamara, OTR/L
• Leticia Clark-Olivero
• Brian Keith Clark, LCSW
• Charnet Yvette Clark
• Connor Reid Clark, PT
• Dan Clark
• Harold Jewett Clark Jr., NMHC, ASSOC

• Clinical Psychologist in Everett, WA
• Providers in Everett, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.