MR. EDWARD DERBY CLARK I (NPI# 1093028870) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093028870 |
| Entity Type | Individual |
| Full Name | MR. EDWARD DERBY CLARK I |
| Practice Address |
1355 Pebblewood Dr Sacramento CA 95833-1612 |
| Practice Telephone | 9162899380 |
| Practice Fax Number | 9164411758 |
| Mailing Telephone | 9162899380 |
| Mailing Fax Number | 9164411758 |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2015-06-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043570732 | Edward Clark | Counselor | 4015 Nine Mcfarland Dr, Suite #175, Alpharetta, GA 30004-8493 | 2012-05-29 |
| 1053474080 | Edward Joseph Clark IIi | Radiology | 1705 S. Tarboro St, Wilson, NC 27893 | 2006-12-19 |
| 1730294232 | Edward Deallen Clark | Obstetrics & Gynecology | 1600 W College St Ste Ll10, Grapevine, TX 76051-3598 | 2006-08-21 |
| 1205843604 | Edward Mark Clark | Dentist | 5211 Yellowstone Rd, Ste # 1, Cheyenne, WY 82009-4761 | 2006-08-01 |
| 1528074523 | Edward Lee Clark | Dentist | 2727 Sw 17th Pl, Redmond, OR 97756-1297 | 2006-07-31 |
| 1124028311 | Edward C Clark | Ophthalmology | 11355 Pembrooke Sq, Suite 107, Waldorf, MD 20603-4805 | 2005-07-28 |
| 1013917814 | Edward C Clark | Internal Medicine | 311 W 24th St, Suite 402, Erie, PA 16502-2665 | 2005-07-22 |
| 1063072429 | Edward Clark | Technician | 1310 6th St Nw, Washington, DC 20001-3495 | 2019-06-18 |
| 1710490800 | Edward E Clark Jr. | Registered Nurse | 10 Penfield Ave, Akron, OH 44310-2912 | 2017-11-10 |
| 1033638424 | Edward Clark | Licensed Practical Nurse | 6600 E Ben White Blvd, Austin, TX 78741-7537 | 2017-09-17 |
| Street Address |
1355 PEBBLEWOOD DR |
| City | SACRAMENTO |
| State | CA |
| Zip Code | 95833-1612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952931487 | Anisa Sims | Counselor | 2688 Stonecreek Dr Apt 137, Sacramento, CA 95833 | 2020-01-23 |
| 1508385949 | Victoria Gabriella Lobatos | Behavioral Analyst | 2915 Azevedo Dr, Sacramento, CA 95833 | 2017-09-18 |
| 1083131908 | Jody Ellen Sytten | Registered Nurse | 2890 Gateway Oaks, Suite 250, Sacramento, CA 95833 | 2017-08-23 |
| 1588181291 | Nora Catherine Myer | Registered Nurse | 2890 Gateway Oaks Suite 250, Sacramento, CA 95833 | 2017-08-23 |
| 1487177689 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1630 West El Camino Ave, Sacramento, CA 95833 | 2017-07-19 |
| 1013430537 | Daniela Lupe | Social Worker | 2800 Amerian Ave, Sacramento, CA 95833 | 2017-07-18 |
| 1194170563 | Tia Lorraine Johnson | Behavioral Analyst | 1416 Brewerton Dr #306, Sacramento, CA 95833 | 2016-05-04 |
| 1053751081 | Kelley Davenport | Behavioral Analyst | 2150 River Plaza Dr Ste 410, Sacramento, CA 95833 | 2013-07-05 |
| 1194075671 | Jennifer Lynn Reddy | Pharmacist | 2200 River Plaza Drive, Sacramento, CA 95833 | 2012-09-12 |
| 1851693295 | Ponce De Leon Dental | Dentist | 1589 W. El Camino Ave., Ste. 108, Sacramento, CA 95833 | 2010-11-17 |
| Find all providers in zip 95833 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508472440 | Jamie Lee Byrnes | Counselor | 777 12th St Ste 250, Sacramento, CA 95814-1929 | 2020-09-16 |
| 1104431519 | Sally Kathleen Montazer | Counselor | 1134 Clinton Rd, Sacramento, CA 95825-7304 | 2020-09-11 |
| 1255958187 | Douglas Benjamin Gudeman | Counselor | Alternative House-residential Treatment Center, 1550 Juliesse Avenue, Sacramento, CA 95815 | 2020-06-26 |
| 1972127611 | Brianna Hope Barron | Counselor | 8950 Cal Center Dr Ste 160&165, Sacramento, CA 95826-3259 | 2020-05-28 |
| 1699398420 | Selena Marie Brown | Counselor | 8084 Weeping Willow Ln, Sacramento, CA 95828-5395 | 2020-05-27 |
| 1346863222 | Erin Harris | Counselor | 2819 Norcade Cir Apt 1, Sacramento, CA 95826-3427 | 2020-05-26 |
| 1023638566 | Marta Yomara Rodriguez | Counselor | 5311 College Oak Dr Apt 16, Sacramento, CA 95841-2575 | 2020-04-24 |
| 1033739321 | Yancey Outreach International Inc. | Counselor | 1457 Dreamy Way, Sacramento, CA 95835-1761 | 2020-04-16 |
| 1114554136 | Cassandra Arlene Del Toro Ruiz | Counselor | 2403 Yreka Ave # 15, Sacramento, CA 95822-4466 | 2020-03-27 |
| 1952931487 | Anisa Sims | Counselor | 2688 Stonecreek Dr Apt 137, Sacramento, CA 95833 | 2020-01-23 |
| Find all providers in SACRAMENTO | ||||
| City | SACRAMENTO |
| Zip Code | 95833 |
Please comment or provide details below to improve the information on MR. EDWARD DERBY CLARK I.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.