Carissa J Van Den Berk-Clark, PHD, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

150.103768 Issued in IL

Practice address

805 Saint Francis Way
Litchfield, IL 62056-1779

Phone

(217) 250-2380

NPI assigned

May 16, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: carissa.vandenberkclark.p30@direct.fhn-fqhc.nextgenshare.com

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.

• Macoupin County Public Health Department

  • Federally Qualified Health Center (FQHC)
  • Gillespie, IL
  • NPI 1538444906
  Medicare reassignment NPD
• Macoupin County Public Health Department

  • Federally Qualified Health Center (FQHC)
  • Litchfield, IL
  • NPI 1720687841
  NPD
• Macoupin County Public Health Department

  • Federally Qualified Health Center (FQHC)
  • Carlinville, IL
  • NPI 1861800526
  NPD

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

{
    "created_epoch": "1715817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715817600000",
    "number": "1609625136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 S SPRING AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631102520",
            "telephone_number": "314-977-4840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 SAINT FRANCIS WAY",
            "city": "LITCHFIELD",
            "state": "IL",
            "postal_code": "620561779",
            "telephone_number": "217-250-2380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DEN BERK-CLARK",
        "first_name": "CARISSA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PHD, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-16",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2022015061",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "150.103768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheryl A Stevenson, DMD
• Ryan Joseph Stice, D.C.
• Sullivan Drugs of Litchfield Inc
• Toofan Medical Holdings, LTD
• Toofan Medical Holdings, LTD
• James Brian Verson, HIS
• Bradley Keith Virgin, D.C.,CCSP
• Amanda Marie Vogel, FNP-C PMHNP-BC
• Vono Pharmacy & Convenient Center, Inc.
• Elizabeth Voss

• Clinical Social Worker in Litchfield, IL
• Providers in Litchfield, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.