Provider Demographics
NPI:1255459723
Name:CLEMENTE-CRAIN, VALARIE ANN (EDD)
Entity type:Individual
Prefix:DR
First Name:VALARIE
Middle Name:ANN
Last Name:CLEMENTE-CRAIN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 FORTUNE BLVD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1741
Mailing Address - Country:US
Mailing Address - Phone:508-473-7400
Mailing Address - Fax:508-473-6643
Practice Address - Street 1:409 FORTUNE BLVD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1741
Practice Address - Country:US
Practice Address - Phone:508-473-7400
Practice Address - Fax:508-473-6643
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1574101YM0800X
MA7445103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
W50444Medicare ID - Type Unspecified