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General NPI Number Information
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NPI Number | 1053444331
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Entity Type | Individual
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Provider Name | JENNIFER CLARK LICSW
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Gender | Female
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6 PLEASANT ST 6TH FLOOR
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City | MALDEN
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State | MA
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Zip | 02148-5100
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Country | US
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Telephone | 781-322-1503
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Fax |
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Provider Business Mailing Address
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Address Line | 184 CROSS ST
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City | WINCHESTER
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State | MA
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Zip | 01890-1118
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Country | US
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Telephone | 508-414-3890
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 113339
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License Number State | MA
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