Nicole Renae Clark, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

3619C Issued in AL

Practice address

48 Medical Park Dr E
Birmingham, AL 35235-3400

Phone

(205) 517-7730

NPI assigned

Aug 4, 2022

Last updated

Aug 4, 2022By the provider in NPPES

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

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1659571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659571200000",
    "number": "1841927415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 27TH AVE NW",
            "city": "CENTER POINT",
            "state": "AL",
            "postal_code": "352152216",
            "telephone_number": "205-482-2739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 MEDICAL PARK DR E",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352353400",
            "telephone_number": "205-517-7730"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 27th Ave NW",
            "address_purpose": "LOCATION",
            "city": "Center Point",
            "state": "AL",
            "postal_code": "352152216",
            "country_code": "US",
            "telephone_number": "205-482-2739",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "NICOLE",
        "middle_name": "RENAE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-04",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AL",
            "license": "3619C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Manay Clark, O.D.
• Matthew Gill Clark, M.D.
• Melissa B Clark, OT
• Michael Dean Clark Jr.
• Myra Clark
• Owen Matthew Clark, MD
• Sally Marie Clark, MS, CCC-SLP
• Sara Emily Allen Clark, M.D.
• Stephen T Clark, M.D.
• Timothy M. Clark, CRNA

• Clinical Social Worker in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Clinical Social Worker in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2022; 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.