Rebecca Elizabeth Clark

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC06081000 Issued in NJ

Practice address

168 Fern Ave
Collingswood, NJ 08108-1938

Phone

(732) 310-7343

NPI assigned

Nov 22, 2022

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

Enrolled in NJ

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.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lifebulb LLCGroup PAC ID 2062881162, 97 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Lifebulb LLC

  • Mental Health Counselor
  • Toms River, NJ
  • NPI 1699491464
  Medicare reassignment Care Compare group NPD
• Perspectiva Counseling LLC

  • Clinical Social Worker
  • Watchung, NJ
  • NPI 1801732649
  NPD
• Thrive Counseling LLC

  dba Thriveworks

  • Mental Health Counselor
  • Lynchburg, VA
  • NPI 1215181300
  NPD

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

{
    "created_epoch": "1669075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669075200000",
    "number": "1487363016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 WILSON ST",
            "city": "MIDDLESEX",
            "state": "NJ",
            "postal_code": "088461425",
            "telephone_number": "732-310-7343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "168 FERN AVE",
            "city": "COLLINGSWOOD",
            "state": "NJ",
            "postal_code": "081081938",
            "telephone_number": "732-310-7343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "REBECCA",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-22",
        "last_updated": "2022-11-22",
        "certification_date": "2022-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC06081000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abigail Charpentier
• Christine A Chew, OT
• Children's Opportunity Center
• Ronald P. Ciccone, M.D.
• Johanna Daniela Clark, LCSW
• Joseph Samuel Cohen
• Alex A. Colalillo Jr., D.D.S.
• Karen Cole
• Monica Collazo
• Collingswood Cerebral Palsy Adult Activity Center

• Clinical Social Worker in Collingswood, NJ
• Providers in Collingswood, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2022; 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.