Ian Clark, PSYD
Individual provider Active NPI Clinical Psychologist · Leeds, MA
NPI 1588099170 · NPPES record last updated Sep 26, 2023
Key facts
- NPI
- 1588099170
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 10454 (MA)
- Practice address
- 421 N Main St
Leeds, MA 01053-9764 - Phone
- (413) 584-4040
- NPI assigned
- Sep 13, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10454 | MA | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 10454 | MA | Yes |
Addresses
Primary practice location
421 N Main St
Leeds, MA 01053-9764
Mailing address
421 N Main St
Leeds, MA 01053-9764
Phone (413) 584-4040
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1300881 | Medicaid | MA |
Other providers in Leeds, MA
- Maureen Patricia Chapman
- Matthew J Charette
- Abraham Chen
- Amanda Chen
- John Randall Christopher
- Raimonda Kathryn Clarke
- Christie Lee Clovis
- Ingrid Elisabeth Cochet
- Sylvia Clemens Coia
- Mary Coleman
All providers in Leeds, MA · Clinical Psychologist in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.