Basic Information
| Provider Information | |||||||||
| NPI: | 1598983629 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VERONICA L. CLEMENT PH.D. PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 172326 | ||||||||
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| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336720326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278248226 | ||||||||
| FaxNumber: | 7278247133 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 7TH ST S | ||||||||
| Address2: | NEUROPSYCHOLOGY | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337014704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278248226 | ||||||||
| FaxNumber: | 7278247133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 12/11/2007 | ||||||||
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| AuthorizedOfficialLastName: | CLEMENT | ||||||||
| AuthorizedOfficialFirstName: | VERONICA | ||||||||
| AuthorizedOfficialMiddleName: | LUCIE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7278248226 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | PY5362 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.