Clark, Sandra Ann

Clark, Sandra Ann is an individual health care provider with primary practice located at 25 Old Ferry Ln , Kittery ME 03904-1305. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Clark, Sandra Ann can be contacted via phone (207) 439-5149.

Contact Information

Primary practice address
25 Old Ferry Ln Kittery ME 03904-1305
Phone: (207) 439-5149
Fax: (207) 439-6001
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X LC3768 Maine
Behavioral Health & Social Service Providers / Clinical 1041C0700X LICSW298 New Hampshire
Behavioral Health & Social Service Providers / Clinical 1041C0700X LICSW1017961 Massachusetts

Profile Details

NPI number 1104862341
LBN Legal business name Clark, Sandra Ann
Credentials MSW
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2006
Last updated Jul 8th, 2007 - about 17 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 1104862341 NPPES
Massachusetts MEDICAID 0024738
Massachusetts MEDICAID 30420808

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