Healthcare Provider Details

I. General information

NPI: 1356246631
Provider Name (Legal Business Name): AMANDA CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEETING HOUSE RD STE 11
CHELMSFORD MA
01824-2737
US

IV. Provider business mailing address

96 W MAIN ST
MERRIMAC MA
01860-2255
US

V. Phone/Fax

Practice location:
  • Phone: 978-485-4722
  • Fax:
Mailing address:
  • Phone: 978-888-7829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: