Alice Ann Clark, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

048.0057921 Issued in VT

Practice address

55 S Main St
Waterbury, VT 05676-1556

Phone

(802) 585-0297

NPI assigned

Jan 8, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 17, 2020 through Jul 17, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Two Brattle Center, P.C.

  • Psychiatry Physician
  • Cambridge, MA
  • NPI 1396792628
  NPD (past)

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291161600000",
    "number": "1598813073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 458",
            "city": "STOWE",
            "state": "VT",
            "postal_code": "056720458",
            "telephone_number": "802-585-0297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 S MAIN ST",
            "city": "WATERBURY",
            "state": "VT",
            "postal_code": "056761556",
            "telephone_number": "802-585-0297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ALICE",
        "middle_name": "ANN",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-08",
        "last_updated": "2010-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "7094",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VT",
            "license": "048.0057921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "W06Z86",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katharina Cahill, PHARM D
• Craig A Cammann, LAC., DAC, DIPL. AC,
• Laurie A. Carcieri, BS
• Alison Chick, PA
• Chloe Rose Smith, PLLC
• Karinne Comenzo, MA, LICSW, LADC
• William J Cove, DO
• Emily Hayworth Dabrowski, MPT
• Elizabeth A Danyew, LCMHC
• Rhiannon Leigh Davis, PTA

• Clinical Psychologist in Waterbury, VT
• Providers in Waterbury, VT by specialty
• Clinical Psychologist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.