Active NPI
Andrea Clark, LCSW
- Mental Health Counselor
- New York, NY
National Provider Identifier
1477593580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 069627-1
- Practice address
- 120 W 57TH St
8TH Floor
New York, NY 10019-3320 - Phone
- (212) 632-4674
- Fax
- (212) 632-4495
- NPI assigned
- Jun 7, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 069627-1 | NY | Primary |
Addresses
Primary practice location
120 W 57TH St
8TH Floor
New York, NY 10019-3320
Mailing address
120 W 57TH St
8TH Floor
New York, NY 10019-3320
Phone (212) 632-4674
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 069627-1 | NY | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jewish Board of Family and Children'S Services, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Addiction (Substance Use Disorder) Counselor
- Brooklyn, NY
- NPI 1760173579
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1477593580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 W 57TH ST",
"address_2": "8TH FLOOR",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100193320",
"telephone_number": "212-632-4674",
"fax_number": "212-632-4495"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 W 57TH ST",
"address_2": "8TH FLOOR",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100193320",
"telephone_number": "212-632-4674",
"fax_number": "212-632-4495"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ANDREA",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-07",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "069627-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.