Andrea Clark LCSW LLC

Key facts

NPI

1700660412

Entity type

Organization (NPI type 2)

Primary specialty

Clinical Social Worker 1041C0700X

Legal business name

ANDREA CLARK LCSW LLC

Practice address

1530 Vance Ave
Fort Wayne, IN 46805-2246

Phone

(260) 200-3988

NPI assigned

Aug 23, 2023

Organization subpart

No

Authorized official

Name

Andrea Clark NPI 1508649070

Title

Owner

Phone

(260) 200-3988

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrea Clark Clinical Social Worker · Fort Wayne, IN · NPI 1508649070
  Medicare reassignment NPD Authorized official CLINICAL · IN

Medicare participation

Medicare fee-for-service enrollment

Enrolled in IN

Medicare enrollment records

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 3, 2025.

{
    "created_epoch": "1692748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756857600000",
    "number": "1700660412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 VANCE AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468052246",
            "telephone_number": "260-200-3988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 VANCE AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468052246",
            "telephone_number": "260-200-3988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREA CLARK LCSW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-23",
        "last_updated": "2025-09-03",
        "certification_date": "2025-09-03",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-200-3988"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Fort Wayne, IN · Clinical Social Worker in Indiana