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

Mary Kenley Clark, LICSW

Individual provider Clinical Social Worker · NPI 1639053929

Mary Kenley Clark, LICSW is a Clinical Social Worker in Ponte Vedra Beach, Florida. Qualified in 2022, 4 years ago. Practices as a sole proprietor. Licensed in Alabama.

Years since qualifying
4
Licensed in
AL
In the registry since
2025
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

See every abbreviation used in this directory →

Practice location Address checks out

310 S Ocean Grande Dr Unit 101
Ponte Vedra Beach, FL 32082-6539
Phone: (251) 422-2148
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 6365C (AL)

Record details

NPI number1639053929
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorYes
NPI enumeratedAugust 1, 2025
Last updated in NPPESAugust 1, 2025
Certification dateAugust 1, 2025

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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