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KELLI MARIE CLARK
NPI 1104196815
Social Worker - Clinical in Massena, NY

Active since January 11, 2012PECOS Enrolled
23 MAPLE ST, MASSENA, NY 13662(315) 769-8441 Get Directions Write a Review

NPPES record last updated: April 24, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kelli Marie Clark NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLI MARIE CLARK (NPI 1104196815) is an individual clinical provider in Massena, New York, licensed in New York (R054044-1) and active in the NPI registry since January 2012. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104196815
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameKELLI MARIE CLARK
Location Address23 MAPLE STMassena, NY 13662-1017
Mailing Address23 Maple StMassena, NY 13662-1017
Phone(315) 769-8441
Sole ProprietorYes
Enumeration DateJanuary 11, 2012
Last NPPES UpdateApril 24, 2018
✔ NPI 1104196815 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in NY · R054044-1
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
23 MAPLE ST, Massena, NY 13662
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelli Marie Clark is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 13662 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $54.87 – $166.88
Typical copayment $0.00 (range $13.71 – $41.72)
Most-billed visit code NA
Established Patient
$68.57 typical visit price
range $17.54 – $136.14
Typical copayment $17.14 (range $4.38 – $34.03)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CYNTHIA MARIE BABBITT LCSWR
Social Worker (Clinical)
23 MAPLE ST
MASSENA, NY 13662
St. Lawrence County (315) 769-8441
WENDY S JOCK
Registered Nurse (Psychiatric/Mental Health, Adult)
23 MAPLE ST
MASSENA, NY 13662
St. Lawrence County (315) 769-8441
MRS. NANCY MARIE ROBIDEAU RN
Registered Nurse
23 MAPLE ST
MASSENA, NY 13662
St. Lawrence County (315) 769-8441
LISA JARVIS RN
Registered Nurse (Psychiatric/Mental Health, Adult)
23 MAPLE ST
MASSENA, NY 13662
St. Lawrence County (315) 769-8441
ATHENA MARIE CURLEY L.M.S.W.
Social Worker (Clinical)
23 MAPLE ST
MASSENA, NY 13662
St. Lawrence County (315) 769-8441
PEGGY ELIZABETH GIBSON REGISTERED NURSE
Registered Nurse (Psychiatric/Mental Health)
23 MAPLE ST
MASSENA, NY 13662
St. Lawrence County (315) 769-8441
MS. SHERI L PAGE RN
Registered Nurse (Psychiatric/Mental Health, Adult)
23 MAPLE ST
MASSENA, NY 13662
St. Lawrence County (315) 769-8441
MR. GEORGE LESHER VANBUSKIRK LCSW
Social Worker (Clinical)
23 MAPLE ST
MASSENA, NY 13662
St. Lawrence County (315) 769-8441

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelli Clark's NPI number?

The NPI number for Kelli Clark is 1104196815. It was assigned to this individual provider in the NPPES registry on January 11, 2012.

Where is Kelli Clark located?

Kelli Clark practices at 23 Maple St, Massena, NY 13662. The listed phone number is (315) 769-8441.

What is Kelli Clark's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Kelli Clark enrolled in Medicare?

Yes. Kelli Clark is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kelli Clark was last updated on April 24, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.