Provider Demographics
NPI:1407592991
Name:CLEMENTE, CHRISTINA DENISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:DENISE
Last Name:CLEMENTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:CHRISTINA
Other - Middle Name:DENISE
Other - Last Name:CLEMENTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:485 LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-1117
Mailing Address - Country:US
Mailing Address - Phone:917-426-1074
Mailing Address - Fax:
Practice Address - Street 1:485 LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-1117
Practice Address - Country:US
Practice Address - Phone:917-426-1074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0932981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical