Patricia R Clark, M.S., LMFT
Individual provider Active NPI Marriage & Family Therapist · Wakefield, RI
NPI 1720122963 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1720122963
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 51 (RI)
- Practice address
- 186 Kettle Pond Dr
Wakefield, RI 02879-5419 - Phone
- (401) 789-7770
- Fax
- (401) 783-3636
- NPI assigned
- Feb 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 51 | RI | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 51 | RI | Yes |
Addresses
Primary practice location
186 Kettle Pond Dr
Wakefield, RI 02879-5419
Mailing address
186 Kettle Pond Dr
Wakefield, RI 02879-5419
Phone (401) 789-7770
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7221-2 | Other | RI | BLUE CROSS & BLUE SHIELD |
Other providers in Wakefield, RI
- David J Chronley
- Brian D Cilley
- Nicole Leslie Cipriani-Fox
- Mary Clair-Michaud
- Cory Clark
- Club Wellbeing LLC
- CMB Wellness LLC
- Coastal Medical, Inc.
- Chad Coffin
- Sally Anne Cole-Major
All providers in Wakefield, RI · Marriage & Family Therapist in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.