Carlton Frederic Clark, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-0011 Issued in AZ

Practice address

9095 E Tanque Verde Rd Unit 171-322
Tucson, AZ 85749-8821

Phone

(520) 519-8475

NPI assigned

Jan 16, 2024

Sex

Male

Sole proprietor

No

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 Dec 12, 2023 through Dec 12, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1705363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1487415501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31454",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857511454",
            "telephone_number": "520-519-8475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9095 E TANQUE VERDE RD UNIT 171-322",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857498821",
            "telephone_number": "520-519-8475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CARLTON",
        "middle_name": "FREDERIC",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-16",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-0011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alessandra Clark, D.O.
• Amber Tressa Clark, PMHNP-BC
• Amy Christine Clark, DO
• Ashley Ellen Clark, C.N.P.
• Candice Ford Clark
• Charles Scott Clark, MD
• Crystal Shawn Clark, CRNA
• Dale Clark, LMT, NCBTMB
• Gerri Renee Clark, R.N.
• Helen Clark

• Clinical Social Worker in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Clinical Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; 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.