Robert Marc Clark, LCSW LICENSED CLINIC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L0751 Issued in OR

Practice address

200 SE Hailey Ave
Suite 301
Pendleton, OR 97801-1329

Phone

(541) 276-4017

Fax

(541) 278-3353

NPI assigned

Dec 28, 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

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Clinical Social Worker

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609932490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 NW 7TH STR",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "97801",
            "telephone_number": "541-276-4017",
            "fax_number": "541-278-3353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SE HAILEY AVE",
            "address_2": "SUITE 301",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978011329",
            "telephone_number": "541-276-4017",
            "fax_number": "541-278-3353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ROBERT",
        "middle_name": "MARC",
        "credential": "LCSW LICENSED CLINIC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L0751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Diane Chrisman, CSWA
• Cody M Cimmiyotti
• City of Pendleton
• Jessica Clark
• Katie A Clark
• Timothy John Clark
• Clearview Disability Resource Center
• Mark Steven Clippinger, MD
• Jacque Cobb, FNP
• Rena I Cochran, CNA

• Clinical Social Worker in Pendleton, OR
• Providers in Pendleton, OR by specialty
• Clinical Social Worker in Oregon

• 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; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.