Individual
ALICE ANN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
55 S MAIN ST, WATERBURY, VT 05676-1556
(802) 585-0297
Mailing address
PO BOX 458, STOWE, VT 05672-0458
(802) 585-0297
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
048.0057921
VT
103TC0700X
Clinical Psychologist
7094
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W06Z86
BCBS
MA
Enumeration date
01/08/2007
Last updated
12/01/2010
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