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Contact Information

JUDITH Z CLARK, PHD
126 OLD MAMMOTH RD
SUITE 214
MAMMOTH LAKES, CA93546
 Phone: 760-924-8503
 Fax: 760-924-0541
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for JUDITH Z CLARK · (Female)

NPI Number 1356440275
Status Active
Credentials PHD
Entity Individual
Enumeration date 09/21/2006
Last updated 09/20/2011 - About 15 years ago
Sole proprietor 1 No
Identifiers
  • CA License # PSY13963
  • CA Medicaid PSY139630
  • Other 11413861 AETNA
  • CA Other CP13963 MEDICARE PTAN
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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