Provider Demographics
NPI:1649641150
Name:CLERMONT, FREDO J (DNP, APRN)
Entity type:Individual
Prefix:DR
First Name:FREDO
Middle Name:J
Last Name:CLERMONT
Suffix:
Gender:M
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 HALL BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2918
Mailing Address - Country:US
Mailing Address - Phone:860-714-9333
Mailing Address - Fax:860-714-8612
Practice Address - Street 1:114 WOODLAND ST FL 7
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-714-2750
Practice Address - Fax:860-714-8612
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006309363LF0000X
CT6309363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT006309OtherLICENSE