Provider Demographics
NPI:1124328570
Name:CLARK, AMY LEIGH (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEIGH
Last Name:CLARK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 TRENTON ST
Mailing Address - Street 2:#412
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-2064
Mailing Address - Country:US
Mailing Address - Phone:989-430-7859
Mailing Address - Fax:
Practice Address - Street 1:1950 TRENTON ST
Practice Address - Street 2:#412
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-2064
Practice Address - Country:US
Practice Address - Phone:989-430-7859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical