George Clark, LICSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

112041 Issued in MA

Practice address

105 Merrick St
Worcester, MA 01609-1937

Phone

(508) 797-6100

Fax

(508) 797-0693

NPI assigned

May 14, 2019

Sex

Male

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

Enrolled in MA

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 Social Worker

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Spectrum Health Systems, IncGroup PAC ID 8224017082, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Spectrum Health Systems, Inc

  • Community/Behavioral Health Agency
  • Worcester, MA
  • NPI 1346430253
  Medicare reassignment Care Compare group NPD
• Spectrum Health Systems Inc

  • Multi-Specialty Clinic/Center
  • Worcester, MA
  • NPI 1376827188
  NPD
• Spectrum Health Systems, Inc

  • Addiction (Substance Use Disorder) Counselor
  • Worcester, MA
  • NPI 1487608485
  NPD (past)

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

{
    "created_epoch": "1557792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557792000000",
    "number": "1801452040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 MECHANIC ST STE 302",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016082419",
            "telephone_number": "508-792-5400",
            "fax_number": "508-831-0074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 MERRICK ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016091937",
            "telephone_number": "508-797-6100",
            "fax_number": "508-797-0693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "GEORGE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-14",
        "last_updated": "2019-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MA",
            "license": "112041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annie H Clark, NP
• Ashley Clark
• Ashley Rose Clark
• Charles David Clark
• Erika L. Clark, PHD
• Haley Brynn Clark
• Holly Lyn Clark, BCBA 1-18-32061
• Jennifer L. Clark, M.D.
• Jennifer Lee Clark, RN-BC
• Laura Beth Clark, LMHC

• Social Worker in Worcester, MA
• Providers in Worcester, MA by specialty
• Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2019; 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.