Provider Demographics
NPI:1174682058
Name:CLEMENT, CLAUDIA JOAN (M ED)
Entity Type:Individual
Prefix:MS
First Name:CLAUDIA
Middle Name:JOAN
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1082
Mailing Address - Street 2:
Mailing Address - City:SUMMERLAND
Mailing Address - State:CA
Mailing Address - Zip Code:93067-1082
Mailing Address - Country:US
Mailing Address - Phone:805-966-1357
Mailing Address - Fax:805-963-1383
Practice Address - Street 1:104 W ARRELLAGA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2916
Practice Address - Country:US
Practice Address - Phone:805-966-1357
Practice Address - Fax:805-963-1383
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACERTIFICATED103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2567OtherADMHS STAFF IDENT. NUMBER