Provider Demographics
NPI:1497769897
Name:CLARK, NANCY L (LCSWR)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:CLARK
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:124 GREEN ST
Mailing Address - Street 2:ULSTER COUNTY MENTAL HEALTH
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4422
Mailing Address - Country:US
Mailing Address - Phone:845-331-3001
Mailing Address - Fax:845-335-4600
Practice Address - Street 1:239 GOLDEN HILL LN
Practice Address - Street 2:ULSTER COUNTY MENTAL HEALTH
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6441
Practice Address - Country:US
Practice Address - Phone:845-340-4018
Practice Address - Fax:845-340-4070
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0784841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY073084OtherLICENSE NO