Active NPI
Jennifer K Clark, PH.D.
- Clinical Psychologist
- South Riding, VA
National Provider Identifier
1992088611
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810004270
- Practice address
- 43130 Amberwood PLZ
Suite 140
South Riding, VA 20152-4105 - Phone
- (703) 542-7770
- NPI assigned
- Sep 20, 2011
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810004270 | VA | Primary |
Addresses
Primary practice location
43130 Amberwood PLZ
Suite 140
South Riding, VA 20152-4105
Mailing address
43130 Amberwood PLZ
Suite 140
South Riding, VA 20152-4105
Phone (703) 542-7770
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810004270 | VA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dominion Center for Behavioral Health Services | Clinical | 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.
-
- Cognitive & Behavioral Psychologist
- South Riding, VA
- NPI 1043595770
Clinical
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323648000000",
"number": "1992088611",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43130 AMBERWOOD PLZ",
"address_2": "SUITE 140",
"city": "SOUTH RIDING",
"state": "VA",
"postal_code": "201524105",
"telephone_number": "703-542-7770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "43130 AMBERWOOD PLZ",
"address_2": "SUITE 140",
"city": "SOUTH RIDING",
"state": "VA",
"postal_code": "201524105",
"telephone_number": "703-542-7770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JENNIFER",
"middle_name": "K",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-20",
"last_updated": "2011-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810004270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Riding, VA
- Carl M. Steger, DDS & Associates, PLLC
- Chiron Diagnostics, LLC
- Chiron Physical Therapy LLC
- Chiron Physical Therapy of VA, LLC
- Gohar Choudhary, M.D
- Cornerstone Therapy Center & Preschool, LLC
- Monica Truong Dinh, D.D.S., M.S.
- Dominion Center for Behavioral Health Services
- Dream Smile Family Dentistry, PLC
- Karol Rose Duffy, NP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.