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Anitra M Clark

Social Worker

Behavioral Health & Social Service Providers

375 Estudillo Ave, Ste 207, San Leandro, CA 94577

PECOS Enrollment

This provider is enrolled in PECOS as ANITRA CLARK.

Based on the most recent information from CMS, provider Anitra M Clark is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1649280595
Provider Type
Individual
Full Name
Clark, Anitra M
Title
Ms.
Credential
LCSW

Gender
Female
Sole Proprietor
Yes
Enumeration Date
8/9/2006
Last Updated
2/11/2022

Contact Information

Practice Location

375 Estudillo Ave, Ste 207, San Leandro, CA 94577

(510) 241-2373

(614) 455-1945

Mailing Location

375 Estudillo Ave, Ste 207, San Leandro, CA 94577

(510) 241-2373

(614) 455-1945

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License LCS26654 California
Code 1041C0700X	Description Social Worker Behavioral Health & Social Service Providers	License 26654 California

Anitra M Clark

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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Perry, Ellen Elizabeth

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Gil, Jesenia Janeth

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