Jack Malcolm Clark III, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

36151 Issued in TX

Practice address

7711 Madonna
San Antonio, TX 78216-6620

Phone

(210) 377-1133

Fax

(210) 377-1230

NPI assigned

Apr 2, 2007

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

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.

• Catholic Charities Archdiocese of San Antonio Inc

  dba Catholic Counseling & Consultation Center

  • Clinical Social Worker
  • San Antonio, TX
  • NPI 1669506192
  Medicare reassignment NPD
• Deer Oaks Geriatric Services P C

  dba Deer Oaks Consultation Services

  • Clinical Psychologist
  • San Antonio, TX
  • NPI 1134169287
  NPD (past)
• Deer Oaks Mental Health Associates PC

  • Clinical Psychologist
  • Las Cruces, NM
  • NPI 1134175763
  NPD (past)

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621814400000",
    "number": "1841311487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BROOKE ARMY MEDICAL CENTER",
            "city": "FT. SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "210-916-3704",
            "fax_number": "210-916-8410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7711 MADONNA",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782166620",
            "telephone_number": "210-377-1133",
            "fax_number": "210-377-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JACK",
        "middle_name": "MALCOLM",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "36151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLARK  BCBS",
            "identifier": "87614Q",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "175693402",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diann Delgado Clark
• Elizabeth Clark
• Elizabeth Clark, LCSW
• Erica Clark, MS, CCC-SLP
• Heather Clark, LPC-ASSOCIATE
• James Clark, R.PH.
• Jessica Lee Clark, RN
• John Woodrow Clark, PTA
• Karla Clark
• Kevin Michael Clark, DDS

• Clinical Social Worker in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; 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.