Individual
TERRELL A CLARK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
9 HOPE AVE, WALTHAM, MA 02453-2741
(781) 216-2200
(781) 647-8914
Mailing address
34 MEADOW RD, BOLTON, MA 01740-1120
(978) 779-6133
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
2856
MA
Other
Enumeration date
02/11/2006
Last updated
07/08/2007
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