Provider Demographics
NPI:1326397464
Name:CLEMENTELLI, KATHLYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLYN
Middle Name:
Last Name:CLEMENTELLI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KATHLYN
Other - Middle Name:
Other - Last Name:CLEMENTELLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3425 S BASCOM AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-7321
Mailing Address - Country:US
Mailing Address - Phone:408-204-8518
Mailing Address - Fax:
Practice Address - Street 1:3425 S BASCOM AVE STE 250
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-7321
Practice Address - Country:US
Practice Address - Phone:408-204-8518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28217103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical