Clark, Alice Ann

Clark, Alice Ann is an sole proprietor health care provider with primary practice located at 55 S Main St , Waterbury VT 05676-1556. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Clark, Alice Ann can be contacted via phone (802) 585-0297.

Contact Information

Primary practice address
55 S Main St Waterbury VT 05676-1556
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 7094 Massachusetts
Behavioral Health & Social Service Providers / Clinical 103TC0700X 048.0057921 Vermont

Profile Details

NPI number 1598813073
LBN Legal business name Clark, Alice Ann
Credentials PHD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 8th, 2007
Last updated Dec 1st, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598813073 NPPES
Massachusetts Other W06Z86 BCBS

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