1043281967 NPI number — DR. ROSIMERI CRISTINA CLEMENTS PSY.D.

Table of content: DR. ROSIMERI CRISTINA CLEMENTS PSY.D. (NPI 1043281967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043281967 NPI number — DR. ROSIMERI CRISTINA CLEMENTS PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLEMENTS
Provider First Name:
ROSIMERI
Provider Middle Name:
CRISTINA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043281967
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 WAYMONT CT
Provider Second Line Business Mailing Address:
STE 111
Provider Business Mailing Address City Name:
LAKE MARY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32746-3572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-804-8975
Provider Business Mailing Address Fax Number:
407-650-3152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 WAYMONT CT
Provider Second Line Business Practice Location Address:
STE 111
Provider Business Practice Location Address City Name:
LAKE MARY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32746-3572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-804-8975
Provider Business Practice Location Address Fax Number:
407-650-3152
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PY6091 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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