Individual
BRAD CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
216 VAUGHAN ST, PORTLAND, ME 04102-3204
(207) 662-2469
Mailing address
216 VAUGHAN ST, PORTLAND, ME 04102-3204
(207) 662-2469
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
MC22300
ME
Other
Enumeration date
07/21/2023
Last updated
07/21/2023
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