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General NPI Number Information
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NPI Number | 1164417424
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Entity Type | Organization
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Legal Business Name | CLARK-DOOLITTLE ASSOC PC
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 71 WALKER ST
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City | CAMBRIDGE
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State | MA
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Zip | 02138-2414
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Country | US
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Telephone | 617-547-7292
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Fax |
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Provider Business Mailing Address
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Address Line | 71 WALKER ST
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City | CAMBRIDGE
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State | MA
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Zip | 02138-2414
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Country | US
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Telephone | 617-547-7292
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Fax | 802-763-2182
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Authorized Official
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Title or Position | OWNER
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Name | MS. KIM CLARK
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Credential | LICSW
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Telephone | 617-547-7292
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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 | 0890000559
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 101057
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License Number State | MA
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