Provider Demographics
NPI:1487755351
Name:CLARK, LORRAINE BETH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:BETH
Last Name:CLARK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LORRAINE
Other - Middle Name:BETH
Other - Last Name:WINSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5202 TEXANA DR
Mailing Address - Street 2:APT #1426
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3772
Mailing Address - Country:US
Mailing Address - Phone:210-724-7798
Mailing Address - Fax:
Practice Address - Street 1:5202 TEXANA DR
Practice Address - Street 2:APT #1426
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3772
Practice Address - Country:US
Practice Address - Phone:210-724-7798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI32761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical