Mary Bradford Clark, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

17311 Issued in MN

Practice address

6401 University Ave NE
Suite 304 Bhsi LLC
Fridley, MN 55432-4344

Phone

(651) 769-6250

Fax

(651) 769-6299

NPI assigned

Oct 5, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bhsi, LLC

  • Clinical Psychologist
  • North Saint Paul, MN
  • NPI 1174635643
  NPD (past)
• Choices Psychotherapy, LTD.

  • Professional Counselor
  • Minnetonka, MN
  • NPI 1134171127
  NPD (past)

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659468437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2497 7TH AVE E",
            "address_2": "SUITE 101 C/O BHSI LLC",
            "city": "NORTH SAINT PAUL",
            "state": "MN",
            "postal_code": "551092496",
            "telephone_number": "651-769-6437",
            "fax_number": "651-769-6426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6401 UNIVERSITY AVE NE",
            "address_2": "SUITE 304 BHSI LLC",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554324344",
            "telephone_number": "651-769-6250",
            "fax_number": "651-769-6299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MARY",
        "middle_name": "BRADFORD",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "17311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Kemoni Chweyah, M.D.
• Brianna Ciaccio
• Cities Lung Clinic PA (Cities Lung Clinic)
• City Home Healthcare LLC
• Sierra May Claeson, MA, LMFT
• Igronata Miracle Clay
• Clear Passage Counseling
• Keith Clepper, LICSW, LADC
• Brian Paul Cloutier
• Mekena Coakley, MS, LADC, LPCC

• Clinical Social Worker in Fridley, MN
• Providers in Fridley, MN by specialty
• Clinical Social Worker in Minnesota

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.