Elizabeth F Clark, PH.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

7190 Issued in MA

Practice address

16 Gleasondale Rd
Stow, MA 01775-1465

Phone

(978) 295-9090

NPI assigned

Jun 26, 2018

Last updated

Jun 26, 2018By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1529971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529971200000",
    "number": "1548755176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 381006",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "022381006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 GLEASONDALE RD",
            "city": "STOW",
            "state": "MA",
            "postal_code": "017751465",
            "telephone_number": "978-295-9090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "280 Old Sudbury Rd",
            "address_purpose": "LOCATION",
            "city": "Sudbury",
            "state": "MA",
            "postal_code": "017761843",
            "country_code": "US",
            "telephone_number": "978-443-1085",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ELIZABETH",
        "middle_name": "F",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-26",
        "last_updated": "2018-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MA",
            "license": "7190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynn Brennan
• Karyn Plickert Bristol, LICSW
• Alina Michelle Carter, MS CCC-SLP
• Nichole Cavallaro, MHC
• Amanda Ciulla
• Daiana Dacosta, MS, LMHC
• Ryan Drizen, DC
• Julia Dunning
• Shealee Marie Engen, IHPL2
• Julie Gariepy, M.S., CCC-SLP

• Clinical Child & Adolescent Psychologist in Stow, MA
• Providers in Stow, MA by specialty
• Clinical Child & Adolescent Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.