Provider Demographics
NPI:1598983629
Name:VERONICA L. CLEMENT PH.D. PA
Entity Type:Organization
Organization Name:VERONICA L. CLEMENT PH.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:LUCIE
Authorized Official - Last Name:CLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:727-824-8226
Mailing Address - Street 1:PO BOX 172326
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33672-0326
Mailing Address - Country:US
Mailing Address - Phone:727-824-8226
Mailing Address - Fax:727-824-7133
Practice Address - Street 1:601 7TH ST S
Practice Address - Street 2:NEUROPSYCHOLOGY
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4704
Practice Address - Country:US
Practice Address - Phone:727-824-8226
Practice Address - Fax:727-824-7133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5362103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
54154Medicare PIN
FLS38493Medicare UPIN