Provider Demographics
NPI:1386526168
Name:CLARK, ELIZABETH S
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:S
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 ECHO RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-7178
Mailing Address - Country:US
Mailing Address - Phone:207-838-6194
Mailing Address - Fax:207-692-2490
Practice Address - Street 1:87 ECHO RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-7178
Practice Address - Country:US
Practice Address - Phone:207-838-6194
Practice Address - Fax:207-692-2490
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEHHS39899251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health