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NPI Code Detail

MEDICARE: MS. LAURA BETH CLARK LMHC

MEDICARE: MS. LAURA BETH CLARK LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor6223MA

General Provider Information

NPI Number : 1689850604
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LAURA BETH CLARK LMHC
Provider Business Mailing Address
First Line : 20 CEDAR ST
Second Line :
City : WORCESTER
State : MA
Zip : 01609-2520
Country : US
Telephone Number : 508-753-5425
Fax Number :
Provider Business Practice Location Address
First Line : 20 CEDAR ST
Second Line :
City : WORCESTER
State : MA
Zip : 01609-2520
Country : US
Telephone Number : 508-753-5425
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2008
Last Update Date : 10/26/2010

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