Provider Demographics
NPI:1811312382
Name:CLARK, HELENA JEANETTE (LPC)
Entity type:Individual
Prefix:
First Name:HELENA
Middle Name:JEANETTE
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:HELENA
Other - Middle Name:JEANETTE
Other - Last Name:O'REILLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:400 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1233
Mailing Address - Country:US
Mailing Address - Phone:203-503-3055
Mailing Address - Fax:203-503-3066
Practice Address - Street 1:400 COLUMBUS AVE
Practice Address - Street 2:PATIENT ACCOUNTS
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1233
Practice Address - Country:US
Practice Address - Phone:203-503-3174
Practice Address - Fax:203-503-3183
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid