Provider Demographics
NPI:1033713110
Name:CLEMENT, OLIVIA LEA (APRN)
Entity Type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:LEA
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ABBY RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5511
Mailing Address - Country:US
Mailing Address - Phone:978-808-3067
Mailing Address - Fax:
Practice Address - Street 1:218 EAST RD
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03841-5303
Practice Address - Country:US
Practice Address - Phone:603-329-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH083973-232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry