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Contact Information

MARY A CLARK, PSY.D
3525 W PETERSON AVE
STE 218
CHICAGO, IL60659-3314
 Phone: 773-430-4601
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for MARY A CLARK · (Female)

NPI Number 1013077361
Status Active
Credentials PSY.D
Entity Individual
Enumeration date 12/09/2006
Last updated 02/13/2017 - About 3 years ago
Sole proprietor 1 Yes
Identifiers
  • IL License # 071006752
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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