Angela Roman Clack, PSYD, LPC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

35SI00779900 Issued in NJ

Practice address

200 Davistown Rd Unit 272
Blackwood, NJ 08012-7611

Phone

(856) 875-5335

Fax

(856) 875-5336

NPI assigned

Jun 17, 2008

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Clack Associates, LLC.

  • Professional Counselor
  • Sicklerville, NJ
  • NPI 1235771031
  NPD

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

{
    "created_epoch": "1213660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750636800000",
    "number": "1699935205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 DAVISTOWN RD UNIT 272",
            "city": "BLACKWOOD",
            "state": "NJ",
            "postal_code": "080127611",
            "telephone_number": "856-875-5335",
            "fax_number": "856-875-5336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 DAVISTOWN RD UNIT 272",
            "city": "BLACKWOOD",
            "state": "NJ",
            "postal_code": "080127611",
            "telephone_number": "856-875-5335",
            "fax_number": "856-875-5336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLACK",
        "first_name": "ANGELA",
        "middle_name": "ROMAN",
        "name_prefix": "Dr.",
        "credential": "PSYD, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-17",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NJ",
            "license": "37PC00323700",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35SI00779900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Blackwood, NJ
• Providers in Blackwood, NJ by specialty
• Clinical Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2025; 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.