Provider Demographics
NPI:1487021333
Name:CLAVERO, EMILOU GRACE
Entity Type:Individual
Prefix:
First Name:EMILOU GRACE
Middle Name:
Last Name:CLAVERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64-411 WAIAHU ST
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8019
Mailing Address - Country:US
Mailing Address - Phone:206-353-4871
Mailing Address - Fax:
Practice Address - Street 1:64-411 WAIAHU ST
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8019
Practice Address - Country:US
Practice Address - Phone:206-353-4871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst