Provider Demographics
NPI:1467755736
Name:CLARK, ANN JENNIFER (LCSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:JENNIFER
Last Name:CLARK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 I ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4311
Mailing Address - Country:US
Mailing Address - Phone:916-296-6972
Mailing Address - Fax:
Practice Address - Street 1:2830 I ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4311
Practice Address - Country:US
Practice Address - Phone:916-296-6972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical