Active NPI
Tamika Shantai Clark, LMSW
- School Social Worker
- Largo, MD
National Provider Identifier
1902625916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Social Worker
- License
- G13108
- Practice address
- 1330 McCormick Dr.
Largo, MD 20774 - Phone
- (301) 772-1200
- NPI assigned
- Oct 7, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Social Worker | 1041S0200X | G13108 | MD | Primary |
Addresses
Primary practice location
1330 McCormick Dr.
Largo, MD 20774
Mailing address
9614 Grandhaven Ave
Upper Marlboro, MD 20772-5268
Phone (301) 938-6927
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 |
|---|---|---|---|
| G13108 | MD | MD | School Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Foundation Schools | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Local Education Agency (LEA)
- Largo, MD
- NPI 1356894083
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728259200000",
"number": "1902625916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9614 GRANDHAVEN AVE",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207725268",
"telephone_number": "301-938-6927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1330 MCCORMICK DR.",
"city": "LARGO",
"state": "MD",
"postal_code": "20774",
"telephone_number": "301-772-1200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "TAMIKA",
"middle_name": "SHANTAI",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-10-07",
"last_updated": "2024-10-07",
"certification_date": "2024-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": "MD",
"license": "G13108",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Largo, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.