Provider Demographics
NPI:1720291974
Name:CLEMENT, DAMARIS D (MFT, PSY D)
Entity Type:Individual
Prefix:DR
First Name:DAMARIS
Middle Name:D
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:MFT, PSY D
Other - Prefix:
Other - First Name:MARIS
Other - Middle Name:D
Other - Last Name:CLEMENT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT, PSYD
Mailing Address - Street 1:1418 N SPAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4012
Mailing Address - Country:US
Mailing Address - Phone:323-512-2292
Mailing Address - Fax:323-512-2292
Practice Address - Street 1:9107 WILSHIRE BLVD STE 215
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5522
Practice Address - Country:US
Practice Address - Phone:310-274-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT35027174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist