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Individual
TIMOTHY CLARK
Active
Individual
TIMOTHY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
105406
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003833
PACIFICARE
MA
01
—
792465
TUFTS HEALTH
MA
Enumeration date
09/08/2006
Last updated
07/08/2007
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