| Andrea Clark Lcsw Llc | |
|
1136 Columbia Ave Fort Wayne IN 46805-4312 | |
| (260) 200-3988 | |
| Not Available |
| Full Name | Andrea Clark Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1136 Columbia Ave, Fort Wayne, Indiana |
| Authorized Official Name and Position | Andrea Clark (OWNER) |
| Authorized Official Contact | 8282068640 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Andrea Clark Lcsw Llc 1136 Columbia Ave Fort Wayne IN 46805-4312 Ph: (260) 200-3988 | Andrea Clark Lcsw Llc 1136 Columbia Ave Fort Wayne IN 46805-4312 Ph: (260) 200-3988 |
| NPI Number | 1700660412 |
|---|---|
| Provider Enumeration Date | 08/23/2023 |
| Last Update Date | 10/25/2024 |
| Certification Date | 10/25/2024 |
| Medicare PECOS PAC ID | 1557711439 |
|---|---|
| Medicare Enrollment ID | O20231219003157 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700660412 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Andrea Clark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508649070 PECOS PAC ID: 2466802343 Enrollment ID: I20231219003220 |
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