Active NPI
Rene Theresa Clark
- Addiction (Substance Use Disorder) Counselor
- Mattapan, MA
National Provider Identifier
1922859313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 187893081
- Practice address
- 255 River St
Mattapan, MA 02126-2729 - Phone
- (617) 981-9244
- NPI assigned
- Apr 1, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 187893081 | MA | Primary |
Addresses
Primary practice location
255 River St
Mattapan, MA 02126-2729
Mailing address
75 N Beacon St
Watertown, MA 02472-2671
Phone (617) 661-3991
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 |
|---|---|---|---|
| 187893081 | MA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711929600000",
"number": "1922859313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 N BEACON ST",
"city": "WATERTOWN",
"state": "MA",
"postal_code": "024722671",
"telephone_number": "617-661-3991"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 RIVER ST",
"city": "MATTAPAN",
"state": "MA",
"postal_code": "021262729",
"telephone_number": "617-981-9244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "RENE",
"middle_name": "THERESA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-01",
"last_updated": "2024-04-01",
"certification_date": "2024-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MA",
"license": "187893081",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mattapan, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 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.