Kelly Clark, MA CAGS

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

1074

Practice address

171 Main St
Ste 401
Milford, MA 01757

Phone

(508) 473-4984

Fax

(508) 482-7316

NPI assigned

Sep 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 6, 2024 through Feb 6, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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.

• Castlebrook Counseling Services, Inc.

  • Clinical Social Worker
  • Westborough, MA
  • NPI 1982045860
  NPD (past)

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1598856759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 MAIN ST",
            "address_2": "STE 401",
            "city": "MILFORD",
            "state": "MA",
            "postal_code": "01757",
            "telephone_number": "508-473-4984",
            "fax_number": "508-482-7316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 MAIN ST",
            "address_2": "STE 401",
            "city": "MILFORD",
            "state": "MA",
            "postal_code": "01757",
            "telephone_number": "508-473-4984",
            "fax_number": "508-482-7316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KELLY",
        "credential": "MA CAGS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": "1074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "LM0158",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kayla Amanda Cimini
• Jenny Lynn Cincotta
• Concetta Cippoletti, LMT
• Claflin Hill Corporation (Blaire House of Milford)
• Felisha Clark, DMD
• Danielle A Clarke, LICSW
• Keisha Lee Clausell
• Erin Theresa Cleary
• Valarie Ann Clemente-Crain, ED.D.
• Emmett A Clemente, M.D.

• Mental Health Counselor in Milford, MA
• Providers in Milford, MA by specialty
• Mental Health Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.