Terri Marie Clack, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN2362195 Issued in MA

Practice address

1 Washington Mall Ste 1045
Boston, MA 02108-2603

Phone

(617) 249-4036

Fax

(617) 843-9320

NPI assigned

Dec 5, 2017

Last updated

Apr 29, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, MA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestanccehealth.terriclack@147611.advancedmd-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• HMV Diagnostics

  dba Diagnostic Medical Testing Inc

  • Clinic/Center
  • Holiday, FL
  • NPI 1043460744

  GA

  Medicare reassignment NPD
• United Psychology Center, LLC

  • Psychiatry Physician
  • Atlanta, GA
  • NPI 1063704542
  Medicare reassignment NPD
• Bristol Hospice - Georgia LLC

  • Community Based Hospice Care Agency
  • Atlanta, GA
  • NPI 1558663872
  NPD

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

{
    "created_epoch": "1512432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1487169173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WASHINGTON MALL STE 1045",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021082603",
            "telephone_number": "617-249-4036",
            "fax_number": "617-843-9320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WASHINGTON MALL STE 1045",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021082603",
            "telephone_number": "617-249-4036",
            "fax_number": "617-843-9320"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "169 Libbey Industrial Pkwy",
            "address_purpose": "LOCATION",
            "city": "Weymouth",
            "state": "MA",
            "postal_code": "021893189",
            "country_code": "US",
            "telephone_number": "781-551-0999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLACK",
        "first_name": "TERRI",
        "middle_name": "MARIE",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-05",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2362195",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN214255",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "GA",
            "license": "RN214255",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine L. Civiletto, PHD
• Amanda Civita
• Sevdenur Cizginer Konuk, MD, MPH
• Robyn Claar, PHD
• Rachael Claborn, LICSW
• Aliza Claflin
• Claimed Counseling LLC
• Katherine Ann Clair-Hayes, LICSW, MSW
• Danielle Sara Clair, PA
• Jennifer Clair

• Psychiatric/Mental Health Nurse Practitioner in Boston, MA
• Providers in Boston, MA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.