Provider Demographics
NPI:1851647465
Name:CLARK, NATALIE B (MSW, LICSW, LCDP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:B
Last Name:CLARK
Suffix:
Gender:F
Credentials:MSW, LICSW, LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BRANDON RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-1209
Mailing Address - Country:US
Mailing Address - Phone:401-561-8829
Mailing Address - Fax:401-266-2316
Practice Address - Street 1:55 BRANDON RD
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-1209
Practice Address - Country:US
Practice Address - Phone:401-626-6984
Practice Address - Fax:401-266-2316
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW019401041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical