Provider Demographics
NPI:1114391596
Name:CLARK, TORRY (M S W)
Entity Type:Individual
Prefix:
First Name:TORRY
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:M S W
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 MITHRA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-2340
Mailing Address - Country:US
Mailing Address - Phone:504-338-5911
Mailing Address - Fax:
Practice Address - Street 1:3801 ULLOA ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6940
Practice Address - Country:US
Practice Address - Phone:504-338-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-22
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker