Provider Demographics
NPI:1194520122
Name:CLARK, MACI DANIELLE
Entity type:Individual
Prefix:
First Name:MACI
Middle Name:DANIELLE
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MACI
Other - Middle Name:DANIELLE
Other - Last Name:EWING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 TOWNEPARK CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2338
Mailing Address - Country:US
Mailing Address - Phone:859-436-8485
Mailing Address - Fax:
Practice Address - Street 1:315 TOWNEPARK CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2338
Practice Address - Country:US
Practice Address - Phone:859-436-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker