Provider Demographics
NPI:1982749925
Name:CLARK, STEPHEN A (LICSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:CLARK
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1036
Mailing Address - Country:US
Mailing Address - Phone:413-772-0059
Mailing Address - Fax:
Practice Address - Street 1:329 CONWAY ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1526
Practice Address - Country:US
Practice Address - Phone:413-773-3608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10250281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P23259Medicare ID - Type Unspecified