Provider Demographics
NPI:1326622606
Name:CLARK, MEGAN KATHRYN (RBT)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:KATHRYN
Last Name:CLARK
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4658 NEWINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:MD
Mailing Address - Zip Code:21755
Mailing Address - Country:US
Mailing Address - Phone:240-626-5502
Mailing Address - Fax:
Practice Address - Street 1:706 WEST PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-2170
Practice Address - Country:US
Practice Address - Phone:301-882-7932
Practice Address - Fax:301-500-2173
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-20-125014106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-20-125014OtherREGISTERED BEHAVIOR TECHNICIAN