Healthcare Provider Details

I. General information

NPI: 1962051128
Provider Name (Legal Business Name): RACHEL CLARK LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10910 CLARKSVILLE PIKE
ELLICOTT CITY MD
21042-6106
US

IV. Provider business mailing address

10910 CLARKSVILLE PIKE
ELLICOTT CITY MD
21042-6106
US

V. Phone/Fax

Practice location:
  • Phone: 667-240-4234
  • Fax:
Mailing address:
  • Phone: 917-887-4224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50081969
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27902
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: