| Provider / Organization | NPI | Date Certified |
|---|---|---|
| CHRISTOPHER BRUCE CLARK | 1609944693 | 2024-01-07 |
Christopher B Clark [M] graduated in 2000 and primarily specializes in Clinical Social Worker.
Christopher Bruce Clark is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1609944693. Registration indicates Christopher Bruce Clark is a provider of access to mental health/behavioral health providers services with a specialization in Behavioral Health & Social Service Providers, Social Worker (Behavioral Health & Social Service Providers, Social Worker) (Social Worker: Clinical, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Social Worker Clinical, Behavioral Health & Social Service Providers) (Social Worker, )
| PECOS ID | 5092903401 |
| Registration | PART-B:Y DME:Y HHA:N PMD:N |
| Entity Type | Individual |
| Provider Name | Mr. Christopher Bruce Clark LCSW |
| Practice Office Address | 4455 S 108TH ST GREENFIELD, WI US |
| Practice Office Telephone | 4144275310 |
| Practice Office Fax | 4144275311 |
| Mailing Address | 4455 S 108TH ST GREENFIELD, WI 532282504 US |
| Business Telephone | 4144275310 |
| Business Fax | 4144275311 |
| Direct Messaging Address [] | [email protected] | Direct |
| FHIR URL [] | https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ |
| Code | Practice | License No State |
|---|---|---|
| 1041C0700X PRIMARY | Access to Mental Health/Behavioral Health Providers Behavioral Health & Social Service Providers Social Worker Behavioral Health & Social Service Providers Social Worker Social Worker: Clinical Behavioral Health/Substance Abuse/Psychiatry Social Worker Clinical Behavioral Health & Social Service Providers Social Worker | 8097
WI |
| 1609944693 | MEDICAID | WI |