Healthcare Provider Details

I. General information

NPI: 1174009542
Provider Name (Legal Business Name): KARLIN CLARK LPMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARLI CLARK LPMA

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 HOSPITAL LOOP
BERLIN VT
05602-9523
US

IV. Provider business mailing address

PO BOX 647
MONTPELIER VT
05601-0647
US

V. Phone/Fax

Practice location:
  • Phone: 802-229-0591
  • Fax: 802-223-3667
Mailing address:
  • Phone: 802-229-0591
  • Fax: 802-223-3667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number047.0133668
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: