Active NPI
Mary Catherine Clark, LCSW
- Clinical Social Worker
- Eugene, OR
National Provider Identifier
1497162176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 5899
- Practice address
- 100 River Ave
Eugene, OR 97404-2507 - Phone
- (541) 345-5395
- NPI assigned
- Jul 15, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 5899 | OR | Primary |
Addresses
Primary practice location
100 River Ave
Eugene, OR 97404-2507
Mailing address
1852 Happy LN
#20
Eugene, OR 97401-1847
Phone (541) 852-1733
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5899 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405382400000",
"number": "1497162176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1852 HAPPY LN",
"address_2": "#20",
"city": "EUGENE",
"state": "OR",
"postal_code": "974011847",
"telephone_number": "541-852-1733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 RIVER AVE",
"city": "EUGENE",
"state": "OR",
"postal_code": "974042507",
"telephone_number": "541-345-5395"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "MARY",
"middle_name": "CATHERINE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-07-15",
"last_updated": "2014-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "5899",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.