Clark, Mary Ann

Clark, Mary Ann is an individual health care provider with primary practice located at 300 Riverside Dr E Ste 2000, Bradenton FL 34208-1023. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Clark, Mary Ann can be contacted via phone (941) 746-8822.

Contact Information

Primary practice address
300 Riverside Dr E Ste 2000 Bradenton FL 34208-1023
Fax: (941) 746-8844
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X PY0004772 Florida

Profile Details

NPI number 1174526578
LBN Legal business name Clark, Mary Ann
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date May 31st, 2005
Last updated Oct 18th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174526578 NPPES
Florida Other 59504 BCBS PROVIDER NUMBER

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