Provider Demographics
NPI:1255100319
Name:CLYMER, MADELEINE GAIL (RBT)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:GAIL
Last Name:CLYMER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 TATE LN
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-8439
Mailing Address - Country:US
Mailing Address - Phone:678-641-9159
Mailing Address - Fax:
Practice Address - Street 1:171 CANAL BLVD
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3607
Practice Address - Country:US
Practice Address - Phone:904-900-1439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-23-264868106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician