| Doctor Name: | TERRELL A CLARK |
| NPI Number: | 1043283724 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 2856 |
| Business Practice Address: | 9 Hope Ave Waltham, MA - 024532741 |
| Business Phone Number: | 7812162200 |
| Business Fax Number: | 7816478914 |
| Mailing Address: | 34 Meadow Rd, BOLTON |
| State: | MA |
| Postal Code: | 017401120 |
| Phone Number: | 9787796133 |
| Fax Number: | |
| NPI Enumeration Date: | 02/11/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | 2856 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |