BRIANNA LYN CLARK LCSW
NPI 1124527387
Student in an Organized Health Care Education/Training Program in Rensselaer, NY

Q: What is Brianna Clark's NPI number?

The NPI number for Brianna Clark is 1124527387. It was assigned to this individual provider in the NPPES registry on February 2, 2018.

Q: What is Brianna Clark's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: Is Brianna Clark enrolled in Medicare?

No. Brianna Clark has opted out of Medicare through October 6, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Brianna Clark was last updated on October 4, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.

Active since February 02, 2018Opted out of Medicare · through Oct 6, 2026

620 WASHINGTON AVE, RENSSELAER, NY 12144(518) 272-7073 Get Directions Write a Review

NPPES record last updated: October 4, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Brianna Lyn Clark Lcsw NPPES

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

BRIANNA LYN CLARK LCSW (NPI 1124527387) is an individual student in an organized health care education/training program in Rensselaer, New York and active in the NPI registry since February 2018. She has opted out of Medicare through October 6, 2026 and maintains a secondary practice location in Albany.

NPPES Registry Identity

NPI1124527387

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NameBRIANNA LYN CLARKCredential: LCSW

Location Address620 WASHINGTON AVERensselaer, NY 12144-1300

Mailing Address200 Trillium Ln Ste 6Albany, NY 12203-3818 · (860) 884-1036

Phone(518) 272-7073

Sole ProprietorYes

Enumeration DateFebruary 2, 2018

Last NPPES UpdateOctober 4, 2022

NPPES CertifiedOctober 4, 2022

✔ NPI 1124527387 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X · License 092224 (NY)

620 WASHINGTON AVE, Rensselaer, NY 12144

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Secondary Practice Location 1

Location 1200 Trillium Ln Ste 6Albany, NY 12203-3818 · Phone (860) 884-1036

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Brianna Lyn Clark Lcsw has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from October 6, 2022 through October 6, 2026.

Opt-Out Effective DateOctober 6, 2022

Opt-Out In Effect ThroughOctober 6, 2026Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 11

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

TARYN HEATH

Social Worker