Individual
DR. MARY ANN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
300 RIVERSIDE DR E, STE 2000, BRADENTON, FL 34208-1023
(941) 746-8822
(941) 746-8844
Mailing address
300 RIVERSIDE DR E, STE 2000, BRADENTON, FL 34208-1023
(941) 746-8822
(941) 746-8844
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY0004772
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59504
BCBS PROVIDER NUMBER
FL
Enumeration date
05/31/2005
Last updated
10/18/2007
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