Individual
BENJAMIN ALEX CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4525 N CENTRAL AVE, PHOENIX, AZ 85012-1889
(602) 764-7818
Mailing address
4637 N 9TH ST, PHOENIX, AZ 85014-3813
(617) 309-0232
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-22348
AZ
1041S0200X
School Social Worker
LCSW-22348
AZ
Other
Enumeration date
07/30/2024
Last updated
02/05/2025
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