Mary McGinn Clark, PH.D.

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

PSY 17897 Issued in CA

Practice address

10981 San Diego Mission Rd
Ste 114
San Diego, CA 92108-2448

Phone

(619) 280-0285

Fax

(619) 280-0286

NPI assigned

May 23, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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 Psychologist

Education

Other, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320105600000",
    "number": "1659374775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10981 SAN DIEGO MISSION RD",
            "address_2": "STE 114",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921082448",
            "telephone_number": "619-280-0285",
            "fax_number": "619-280-0286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10981 SAN DIEGO MISSION RD",
            "address_2": "STE 114",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921082448",
            "telephone_number": "619-280-0285",
            "fax_number": "619-280-0286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MARY",
        "middle_name": "MCGINN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-05-23",
        "last_updated": "2011-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "CA",
            "license": "PSY 17897",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC 17748",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EPS004410",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn M Clark, MPH, RD
• Kayla Clark, PSYD
• Kellie Clark
• Kelsey Elizabeth Clark, MS
• Linnette Ann Clark, PT, PHD
• Matthew Clark
• Maximus Clark
• Meghan Clark
• Michael Clark
• Michelle Alicia Clark

• Counseling Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Counseling Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; 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.