Provider Demographics
NPI:1396798351
Name:CLAVIJO, ALINA MARIA (PHD)
Entity type:Individual
Prefix:
First Name:ALINA
Middle Name:MARIA
Last Name:CLAVIJO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7775 YARDLEY DRIVE
Mailing Address - Street 2:APT. F 105
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-0849
Mailing Address - Country:US
Mailing Address - Phone:317-370-5017
Mailing Address - Fax:
Practice Address - Street 1:8362 SW 8TH ST.
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4180
Practice Address - Country:US
Practice Address - Phone:954-374-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041364A103T00000X
FLPY10403103TB0200X, 103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200247040Medicaid
IN268960DMedicare ID - Type UnspecifiedMCR # FOR CENTER FOR PAIN
IN200247040Medicaid