Cynthia Adrian Clark, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

231 W Main St
Suite 2-W
Carbondale, IL 62901-2948

Phone

(618) 549-1793

Fax

(618) 549-1793

NPI assigned

Mar 16, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740304807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 W MAIN ST STE 2-W",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629012948",
            "telephone_number": "618-549-1793",
            "fax_number": "618-549-1793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 W MAIN ST",
            "address_2": "SUITE 2-W",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629012948",
            "telephone_number": "618-549-1793",
            "fax_number": "618-549-1793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CYNTHIA",
        "middle_name": "ADRIAN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "040796",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH LINK",
            "identifier": "189452",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "039-72018",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fabian Brice Churchill, LSW
• Kathryn Churling, M.D.
• Vadzim Chyzhyk, MD
• Bria Ciganovich, CRNA
• Dominic Cittadino, D.D.S.
• Nathaniel Clark, P.A.
• Sonya Clark, LCSW
• James Clement, M.D.
• Jennifer Lynn Clevenger, CRNA
• Clifford L Coleman & Associates LTD (Clifford L. Coleman, M.D.)

• Psychologist in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Psychologist in Illinois

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.