Provider Demographics
NPI:1174009542
Name:CLARK, KARLIN (LPMA)
Entity Type:Individual
Prefix:
First Name:KARLIN
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPMA
Other - Prefix:
Other - First Name:KARLI
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPMA
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-0647
Mailing Address - Country:US
Mailing Address - Phone:802-229-0591
Mailing Address - Fax:802-223-3667
Practice Address - Street 1:286 HOSPITAL LOOP
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9523
Practice Address - Country:US
Practice Address - Phone:802-229-0591
Practice Address - Fax:802-223-3667
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047.0133668103T00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health