Active NPI
Richard Joseph Clark, PSYD
- Clinical Psychologist
- Glendale, WI
National Provider Identifier
1598839755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1893057
- Practice address
- 6700 N Port Washington Rd
Glendale, WI 53217-3919 - Phone
- (414) 351-0450
- Fax
- (414) 351-8845
- NPI assigned
- Nov 20, 2006
- Last updated
- Apr 25, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1893057 | WI | Primary |
Addresses
Primary practice location
6700 N Port Washington Rd
Glendale, WI 53217-3919
Mailing address
2312 N Grandview Blvd
Suite 104
Waukesha, WI 53188-1600
Phone (262) 522-8512
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 |
|---|---|---|---|
| 1893057 | WI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335312000000",
"number": "1598839755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2312 N GRANDVIEW BLVD",
"address_2": "SUITE 104",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531881600",
"telephone_number": "262-522-8512",
"fax_number": "262-244-0914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6700 N PORT WASHINGTON RD",
"city": "GLENDALE",
"state": "WI",
"postal_code": "532173919",
"telephone_number": "414-351-0450",
"fax_number": "414-351-8845"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "RICHARD",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-20",
"last_updated": "2012-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WI",
"license": "1893057",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, WI
- Erin Elizabeth Christen
- Christopher P. McAboy DDS, LLC
- Jeffrey Allen Cieslak, LAT,AT,C, EMT
- Madeline Rose Cipriano, LPC
- Dusty Clark, PTA
- Cleanslate Medical Group of Wisconsin, SC
- Clear Direction Psychological Services, Inc.
- Clearview Medical Imaging, LLC
- Nakita Dominique Cleveland Hickles, LPC
- Mariah Cloutier, PT, DPT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.