Healthcare Provider Details

I. General information

NPI: 1174446645
Provider Name (Legal Business Name): COASTAL CLINICIANS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BUTTERNUT RD
SUTTON MA
01590-2929
US

IV. Provider business mailing address

7 BUTTERNUT RD
SUTTON MA
01590-2929
US

V. Phone/Fax

Practice location:
  • Phone: 201-240-5932
  • Fax:
Mailing address:
  • Phone: 201-240-5932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KAREN MARIE CLARK
Title or Position: OWNER
Credential: PH.D
Phone: 201-240-6081