Individual
DR. IAN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
421 N MAIN ST, LEEDS, MA 01053-9764
(413) 584-4040
Mailing address
421 N MAIN ST, LEEDS, MA 01053-9764
(413) 584-4040
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
10454
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1300881
—
MA
Enumeration date
09/13/2013
Last updated
09/26/2023
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