Provider Demographics
NPI:1942966346
Name:CLARK, PATRICK L (LMSW)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:L
Last Name:CLARK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12286 N NEW DAWN AVE
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-1602
Mailing Address - Country:US
Mailing Address - Phone:708-473-2043
Mailing Address - Fax:
Practice Address - Street 1:12286 N NEW DAWN AVE
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-1602
Practice Address - Country:US
Practice Address - Phone:708-473-2043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-7071T1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical