Provider Demographics
NPI:1760710651
Name:CLEMENTI, ERICA KARIN (LCSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:KARIN
Last Name:CLEMENTI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 OLD COURTHOUSE SQ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4921
Mailing Address - Country:US
Mailing Address - Phone:707-494-2947
Mailing Address - Fax:
Practice Address - Street 1:50 OLD COURTHOUSE SQ
Practice Address - Street 2:SUITE 400
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4921
Practice Address - Country:US
Practice Address - Phone:707-494-2947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS216111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical