Active NPI
Marie Clark
- Community Health Worker
- San Francisco, CA
National Provider Identifier
1861601122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 101 Gough St
San Francisco, CA 94102-5903 - Phone
- (415) 553-4490
- NPI assigned
- May 22, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | R1247580417 | CA | |
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
101 Gough St
San Francisco, CA 94102-5903
Mailing address
101 Gough St
San Francisco, CA 94102-5903
Phone (415) 553-4490
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R1247580417 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686873600000",
"number": "1861601122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 GOUGH ST",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941025903",
"telephone_number": "415-553-4490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 GOUGH ST",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941025903",
"telephone_number": "415-553-4490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-22",
"last_updated": "2023-06-16",
"certification_date": "2023-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "R1247580417",
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.