Active NPI
Gregory D Clark, MSW
- Clinical Social Worker
- Fargo, ND
National Provider Identifier
1689608952
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LICSW 2973
- Practice address
- 118 Broadway N
Ste 810
Fargo, ND 58102-4949 - Phone
- (701) 799-8785
- Fax
- (701) 205-4930
- NPI assigned
- Jul 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LICSW 2973 | ND | Primary |
Addresses
Primary practice location
118 Broadway N
Ste 810
Fargo, ND 58102-4949
Mailing address
118 Broadway N
Ste 810
Fargo, ND 58102-4949
Phone (701) 799-8785
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 015066 | Other | ND | BCBS OF ND PIN |
| 03Q32CL | Other | MN | BCBS OF MN PIN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LICSW 2973 | ND | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458864000000",
"number": "1689608952",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "118 BROADWAY N",
"address_2": "STE 810",
"city": "FARGO",
"state": "ND",
"postal_code": "581024949",
"telephone_number": "701-799-8785",
"fax_number": "701-205-4930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 BROADWAY N",
"address_2": "STE 810",
"city": "FARGO",
"state": "ND",
"postal_code": "581024949",
"telephone_number": "701-799-8785",
"fax_number": "701-205-4930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "GREGORY",
"middle_name": "D",
"name_prefix": "Mr.",
"credential": "MSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2016-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ND",
"license": "LICSW 2973",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF ND PIN",
"identifier": "015066",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MN PIN",
"identifier": "03Q32CL",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.