Active NPI
Angela J Clark
- Marriage & Family Therapist
- Old Tappan, NJ
National Provider Identifier
1568188290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- AMFT132478
- Practice address
- 48 Bistate Plaza
Old Tappan, NJ 07675 - Phone
- (509) 768-2249
- NPI assigned
- Oct 14, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | AMFT132478 | CA | Primary |
Addresses
Primary practice location
48 Bistate Plaza
Old Tappan, NJ 07675
Mailing address
8940 Rachel Freeman Way Apt 4201
Charlotte, NC 28278-9559
Phone (619) 259-7664
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 |
|---|---|---|---|
| AMFT132478 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1665705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665705600000",
"number": "1568188290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8940 RACHEL FREEMAN WAY APT 4201",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282789559",
"telephone_number": "619-259-7664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "48 BISTATE PLAZA",
"city": "OLD TAPPAN",
"state": "NJ",
"postal_code": "07675",
"telephone_number": "509-768-2249"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ANGELA",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-14",
"last_updated": "2022-10-14",
"certification_date": "2022-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "AMFT132478",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Old Tappan, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.