Provider Demographics
NPI:1629858600
Name:CLEMENTE, IVETTE JAZMIN
Entity Type:Individual
Prefix:
First Name:IVETTE
Middle Name:JAZMIN
Last Name:CLEMENTE
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 1:7108 SOUTH KANNER HWY, STUART, FL
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997
Mailing Address - Country:US
Mailing Address - Phone:185-583-2672
Mailing Address - Fax:
Practice Address - Street 1:215 6TH STREET MAPLE
Practice Address - Street 2:
Practice Address - City:RINGWOOD
Practice Address - State:OK
Practice Address - Zip Code:73768-7376
Practice Address - Country:US
Practice Address - Phone:580-231-9410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst