Provider Demographics
NPI:1801913488
Name:CLEMENT, VERONICA LUCIE (PHD)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:LUCIE
Last Name:CLEMENT
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 1:471 W DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3817
Mailing Address - Country:US
Mailing Address - Phone:813-453-1962
Mailing Address - Fax:
Practice Address - Street 1:471 W DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3817
Practice Address - Country:US
Practice Address - Phone:813-453-1962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5362103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGH592ZMedicare PIN