Christy A Clark, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

7966 Issued in MA

Practice address

300 W Main St
BLDG a
Northborough, MA 01532-2132

Phone

(508) 856-2551

Fax

(508) 856-5320

NPI assigned

Jun 30, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 4, 2022 through Jan 4, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

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.

• Third Wave Therapy & Training PLLC

  • Clinical Psychologist
  • Concord, MA
  • NPI 1386594125
  NPD Authorized official

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466380800000",
    "number": "1760411102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W MAIN ST",
            "address_2": "BLDG A",
            "city": "NORTHBOROUGH",
            "state": "MA",
            "postal_code": "015322132",
            "telephone_number": "508-334-8815",
            "fax_number": "508-334-5374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W MAIN ST",
            "address_2": "BLDG A",
            "city": "NORTHBOROUGH",
            "state": "MA",
            "postal_code": "015322132",
            "telephone_number": "508-856-2551",
            "fax_number": "508-856-5320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHRISTY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2016-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "7966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Marie Charpentier
• Caroly A Cheras, M.S., LMHC, LPC
• Bess Child, LICSW
• Children'S Dentistry of Northborough
• Wan Choi, RPH
• Elena Climov, FNP
• Eloise R Colasanto-Saia, R.D., LDN, C.D.E.
• Cole Psychological and Assessment Services LLC
• Coleman House,LTD
• Confident Counseling

• Clinical Psychologist in Northborough, MA
• Providers in Northborough, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.