| Andrea Clark Lcsw Llc | |
|
4656 W Jefferson Blvd Ste 285 Fort Wayne IN 46804-6838 | |
| (260) 422-9372 | |
| Not Available |
| Full Name | Andrea Clark Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4656 W Jefferson Blvd Ste 285, 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 4656 W Jefferson Blvd Ste 285 Fort Wayne IN 46804-6838 Ph: () - | Andrea Clark Lcsw Llc 4656 W Jefferson Blvd Ste 285 Fort Wayne IN 46804-6838 Ph: (260) 422-9372 |
| NPI Number | 1700660412 |
|---|---|
| Provider Enumeration Date | 08/23/2023 |
| Last Update Date | 08/23/2023 |
| Certification Date | 08/23/2023 |
| 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 |
Prometheus Psychological Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 10214 Chestnut Plaza Dr, Suite 130, Fort Wayne, IN 46814 Phone: 260-409-8188 | |
Christina Stapleton, L.l.c Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 10315 Dawsons Creek Blvd # 12, Fort Wayne, IN 46825 Phone: 260-387-6340 | |
Oaktree Guidance & Wellness Center Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 9910 Dupont Circle Drive, Suite 140, Fort Wayne, IN 46825 Phone: 260-570-4515 Fax: 260-209-0762 | |
Courageous Healing Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2013 S Anthony Blvd, Fort Wayne, IN 46803 Phone: 260-417-4801 | |
Raj Clinics Professional Services Corporation Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 315 Airport North Office Park, Fort Wayne, IN 46825 Phone: 574-732-1166 Fax: 574-753-4117 | |
Sharon Mowrer Counseling And Consulting Pc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1415 Magnavox Way, Suite 120, Fort Wayne, IN 46804 Phone: 260-760-8645 | |
A.w. Holdings, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3900 Hursh Rd, Fort Wayne, IN 46845 Phone: 260-637-3608 |