Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Holly Diane Clark, LICSW

Individual provider Clinical Social Worker · NPI 1649096702

Holly Diane Clark, LICSW is a Clinical Social Worker in Minneapolis, Minnesota. Qualified in 2018, 8 years ago. Practices as a sole proprietor and works from 2 locations. Licensed in Minnesota.

Years since qualifying
8
Licensed in
MN
In the registry since
2024
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

4826 Chicago Ave Ste 105
Minneapolis, MN 55417-1055
Phone: (952) 201-5351
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 333 Washington Ave N Ste 406, Minneapolis, MN 55401-1370 — (971) 220-2127

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 23348 (MN)

Record details

NPI number1649096702
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorYes
NPI enumeratedNovember 22, 2024
Last updated in NPPESSeptember 21, 2025
Certification dateSeptember 21, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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