Provider Demographics
NPI:1629859897
Name:CLEM, NILE
Entity Type:Individual
Prefix:
First Name:NILE
Middle Name:
Last Name:CLEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MOUNT HOPE AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5664
Mailing Address - Country:US
Mailing Address - Phone:207-941-2952
Mailing Address - Fax:207-941-2955
Practice Address - Street 1:700 MOUNT HOPE AVE STE 320
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5664
Practice Address - Country:US
Practice Address - Phone:207-941-2952
Practice Address - Fax:207-941-2955
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC22654104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker