Kelly Clark, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

425 Prospect St
Northampton, MA 01060-2046

Phone

(413) 727-2640

NPI assigned

Apr 3, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

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

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.

• Valera Medical, P.C.

  • Psychiatry Physician
  • Brooklyn, NY
  • NPI 1437782349

  Social Worker

  NPD
• Carson Center for Human Services, Inc.

  • Community/Behavioral Health Agency
  • Westfield, MA
  • NPI 1457385460
  NPD (past)
• The Carson Center

  • Public Health or Welfare Agency
  • Westfield, MA
  • NPI 1215975842
  NPD (past)

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548201600000",
    "number": "1881715068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 PROSPECT ST",
            "city": "NORTHAMPTON",
            "state": "MA",
            "postal_code": "010602046",
            "telephone_number": "413-727-2640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 PROSPECT ST",
            "city": "NORTHAMPTON",
            "state": "MA",
            "postal_code": "010602046",
            "telephone_number": "413-727-2640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KELLY",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-03",
        "last_updated": "2019-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MBHP",
            "identifier": "0300010",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1300881",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kirsten Cirincione, LMHC
• City of Northampton
• City of Northampton (Northampton Public Schools)
• City of Northampton
• Marilyn D Clapp, LMHC
• Clarke School for the Deaf
• Clarke School for the Deaf
• Clarke Schools for Hearing and Speech (Clarke School for the Deaf)
• Clarke Schools for Hearing and Speech (Clarke School for the Deaf)
• Clarke Schools for the Deaf

• Clinical Social Worker in Northampton, MA
• Providers in Northampton, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.