ALICE ANN CLARK PHD
NPI 1598813073
Psychologist - Clinical in Waterbury, VT

Q: What is Alice Clark's NPI number?

The NPI number for Alice Clark is 1598813073. It was assigned to this individual provider in the NPPES registry on January 8, 2007.

Q: What is Alice Clark's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: Is Alice Clark enrolled in Medicare?

No. Alice Clark has opted out of Medicare through July 17, 2028. 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 Alice Clark was last updated on December 1, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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 January 08, 2007Opted out of Medicare · through Jul 17, 2028

55 S MAIN ST, WATERBURY, VT 05676(802) 585-0297 Get Directions Write a Review

NPPES record last updated: December 1, 2010. Verified against the NPPES registry weekly; last sync: September 13, 2026.

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About Alice Ann Clark Phd NPPES

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

ALICE ANN CLARK PHD (NPI 1598813073) is an individual clinical provider in Waterbury, Vermont, licensed in Vermont (048.0057921) and active in the NPI registry since January 2007. She has opted out of Medicare through July 17, 2028.

NPPES Registry Identity

NPI1598813073

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameALICE ANN CLARKCredential: PHD

Location Address55 S MAIN STWaterbury, VT 05676-1556

Mailing AddressPo Box 458Stowe, VT 05672-0458 · (802) 585-0297

Phone(802) 585-0297

Sole ProprietorYes

Enumeration DateJanuary 8, 2007

Last NPPES UpdateDecember 1, 2010

✔ NPI 1598813073 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

Licenses✔ Licensed in VT · 048.0057921✔ Licensed in MA · 7094

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

55 S MAIN ST, Waterbury, VT 05676

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Other Identifiers 2

OtherW06Z86MA · Bcbs

Medicare ID-Type UnspecifiedCLW51246

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Alice Ann Clark Phd 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 July 17, 2020 through July 17, 2028.

Opt-Out Effective DateJuly 17, 2020

Opt-Out In Effect ThroughJuly 17, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 2

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

CAROL L BUCK-ROLLAND NP

Nurse Practitioner (Women's Health)

55 S MAIN ST
WATERBURY, VT 05676

Washington County (802) 244-5651

MS. KAMALA JEAN KELTON LCMHC

Counselor (Mental Health)

55 S MAIN ST, BOX 4
WATERBURY, VT 05676

Washington County (802) 244-7937

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 Alice Clark's NPI number?

The NPI number for Alice Clark is 1598813073. It was assigned to this individual provider in the NPPES registry on January 8, 2007.

Where is Alice Clark located?

Alice Clark practices at 55 S Main St, Waterbury, VT 05676. The listed phone number is (802) 585-0297.

What is Alice Clark's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Alice Clark enrolled in Medicare?

No. Alice Clark has opted out of Medicare through July 17, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Alice Clark was last updated on December 1, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.