Individual
MARY BRADFORD CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
6401 UNIVERSITY AVE NE, SUITE 304 BHSI LLC, FRIDLEY, MN 55432-4344
(651) 769-6250
(651) 769-6299
Mailing address
2497 7TH AVE E, SUITE 101 C/O BHSI LLC, NORTH SAINT PAUL, MN 55109-2496
(651) 769-6437
(651) 769-6426
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
17311
MN
Other
Enumeration date
10/05/2006
Last updated
07/08/2007
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