Active NPI
Roberta Catherine Clark, LS/SW/QMRP
- Social Worker
- Auburn Hills, MI
National Provider Identifier
1609017987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6802035968
- Practice address
- 1270 Doris Rd
Auburn Hills, MI 48326-2617 - Phone
- (248) 276-8044
- NPI assigned
- Mar 16, 2009
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 6802035968 | MI | Primary |
Addresses
Primary practice location
1270 Doris Rd
Auburn Hills, MI 48326-2617
Mailing address
306 Bellarmine Dr
Rochester Hills, MI 48309-1207
Phone (248) 894-7185
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 |
|---|---|---|---|
| 6802035968 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1237161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1237161600000",
"number": "1609017987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "306 BELLARMINE DR",
"city": "ROCHESTER HILLS",
"state": "MI",
"postal_code": "483091207",
"telephone_number": "248-894-7185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1270 DORIS RD",
"city": "AUBURN HILLS",
"state": "MI",
"postal_code": "483262617",
"telephone_number": "248-276-8044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ROBERTA",
"middle_name": "CATHERINE",
"name_prefix": "Ms.",
"credential": "LS/SW/QMRP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-03-16",
"last_updated": "2009-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6802035968",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Auburn Hills, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.