Provider Demographics
NPI:1790004422
Name:CLEMENT, FREDERICK
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:CLEMENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:FREDERICK
Other - Middle Name:
Other - Last Name:CLEMENT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:2249 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-2147
Mailing Address - Country:US
Mailing Address - Phone:609-457-9850
Mailing Address - Fax:
Practice Address - Street 1:2249 SHORE RD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2147
Practice Address - Country:US
Practice Address - Phone:609-457-9850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00163900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist