Provider Demographics
NPI:1467805341
Name:CLEMMONS, SHELBI THERESA (MSW)
Entity Type:Individual
Prefix:
First Name:SHELBI
Middle Name:THERESA
Last Name:CLEMMONS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 NW 2ND AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6763
Mailing Address - Country:US
Mailing Address - Phone:561-706-1004
Mailing Address - Fax:561-892-0268
Practice Address - Street 1:2290 NW 2ND AVE
Practice Address - Street 2:STE 3
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6763
Practice Address - Country:US
Practice Address - Phone:561-706-1004
Practice Address - Fax:561-892-0268
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical