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General NPI Number Information
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NPI Number | 1194651380
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Entity Type | Individual
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Provider Name | MISS MARY KIMBERLY CLARK
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Gender | Female
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Dates
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Enumeration Date | 06/23/2026
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Last Update Date | 06/23/2026
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Provider Practice Location Address
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Address Line | 7090 SAMUEL MORSE DR STE 100-300
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City | COLUMBIA
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State | MD
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Zip | 21046-3442
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Country | US
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Telephone | 855-935-3691
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Fax |
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Provider Business Mailing Address
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Address Line | 104 BROADVIEW BLVD S
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City | GLEN BURNIE
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State | MD
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Zip | 21061-2605
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Country | US
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Telephone | 443-979-6620
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | MD
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