Healthcare Provider Details

I. General information

NPI: 1720942998
Provider Name (Legal Business Name): MADISON ELIZABETH CLARK MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 W 3RD ST
WILLIAMSPORT PA
17701-7808
US

IV. Provider business mailing address

511 TOFTREES AVE APT 207
STATE COLLEGE PA
16803-1962
US

V. Phone/Fax

Practice location:
  • Phone: 570-320-2816
  • Fax: 570-320-0201
Mailing address:
  • Phone: 919-995-7192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW143752
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: