Provider Demographics
NPI:1205137890
Name:CLARK, KATHRYN P (LMHC)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:P
Last Name:CLARK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HALE ST
Mailing Address - Street 2:APT #2
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-4666
Mailing Address - Country:US
Mailing Address - Phone:978-621-5562
Mailing Address - Fax:
Practice Address - Street 1:5 MARKET SQ
Practice Address - Street 2:SUITE 204
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2497
Practice Address - Country:US
Practice Address - Phone:978-621-5562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8252101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health