Individual
MS. SANDRA ANN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
25 OLD FERRY LN, KITTERY, ME 03904-1305
(207) 439-5149
(207) 439-6001
Mailing address
25 OLD FERRY LN, KITTERY, ME 03904-1305
(207) 439-5149
(207) 439-6001
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC3768
ME
1041C0700X
Clinical Social Worker
LICSW1017961
MA
1041C0700X
Clinical Social Worker
LICSW298
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0024738
—
MA
05
—
30420808
—
NH
Enumeration date
06/22/2006
Last updated
07/08/2007
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