Basic Information
| Provider Information | |||||||||
| NPI: | 1023500469 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLARK | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | |||||||||
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| Credential: | BSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 N ROOSEVELT AVE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431302338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404158011 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 68 W CHURCH ST STE 318 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430555050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402811777 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2018 | ||||||||
| LastUpdateDate: | 09/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 172V00000X | Y | Other Service Providers | Community Health Worker |
No ID Information.