Active NPI
Timothy Clark, LICSW
- Social Worker
- West Barnstable, MA
National Provider Identifier
1538263801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 105406
- Practice address
- 1170 Main St RT 6a
West Barnstable, MA 02665 - Phone
- (508) 737-2701
- Fax
- (508) 548-5789
- NPI assigned
- Sep 8, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 105406 | MA | Primary |
Addresses
Primary practice location
1170 Main St RT 6a
West Barnstable, MA 02665
Mailing address
PO Box 905
Falmouth, MA 02541
Phone (508) 548-8989
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 792465 | Other | MA | TUFTS HEALTH |
| 003833 | Other | MA | PACIFICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050928001010 | MA | Practitioner - Clinical Social Worker | 7315972312 | Practice locations: W Barnstable, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1025 Main St
FL 1
W Barnstable, MA 02668-1163
Phone (508) 737-2701
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105406 | MA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1538263801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 905",
"city": "FALMOUTH",
"state": "MA",
"postal_code": "02541",
"telephone_number": "508-548-8989",
"fax_number": "508-548-5789"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1170 MAIN ST RT 6A",
"city": "WEST BARNSTABLE",
"state": "MA",
"postal_code": "02665",
"telephone_number": "508-737-2701",
"fax_number": "508-548-5789"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "TIMOTHY",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "105406",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH",
"identifier": "792465",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PACIFICARE",
"identifier": "003833",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Barnstable, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.