Irene Maria Clark, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

Q1-0001798 Issued in DE

Practice address

3101 N. 29TH St.
Philadelphia, PA 19132

Phone

(404) 740-7747

NPI assigned

Jun 3, 2020

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

Medicare fee-for-service enrollment

Enrolled in DE

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

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, DE

  Medicare reassignment NPD
• Helping & Healing

  • Clinical Social Worker
  • Newark, DE
  • NPI 1003751439
  NPD

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

{
    "created_epoch": "1591142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591142400000",
    "number": "1811511017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3018 W DIAMOND ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191211151",
            "telephone_number": "404-740-7747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 N. 29TH ST.",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19132",
            "telephone_number": "404-740-7747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "IRENE",
        "middle_name": "MARIA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-03",
        "last_updated": "2020-06-03",
        "certification_date": "2020-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "DE",
            "license": "Q1-0001798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Clark, NP
• Claire Alexis Clark, M.S.
• Cynthia Anne Clark, CRNP
• Derek Anthony Clark
• Fabienne A. Clark
• Jae H Clark, ATC, LAT
• Janell Lanice Clark, CRNP
• Jasmen Clark
• Jasmine Clark
• Jessica Clark

• Clinical Social Worker in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.