Provider Demographics
NPI:1043618499
Name:CLARK PINSON, PHD
Entity Type:Organization
Organization Name:CLARK PINSON, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:PINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:315-514-0401
Mailing Address - Street 1:114 N LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2014
Mailing Address - Country:US
Mailing Address - Phone:315-514-0401
Mailing Address - Fax:
Practice Address - Street 1:114 N LOWELL AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2014
Practice Address - Country:US
Practice Address - Phone:315-514-0401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020187302F00000X, 302R00000X, 305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service