Provider Demographics
NPI:1215066758
Name:CLEMENS, LISETTE B (MSW)
Entity type:Individual
Prefix:MS
First Name:LISETTE
Middle Name:B
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4626 CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-3647
Mailing Address - Country:US
Mailing Address - Phone:619-266-2111
Mailing Address - Fax:619-266-0496
Practice Address - Street 1:286 EUCLID AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114
Practice Address - Country:US
Practice Address - Phone:619-266-2111
Practice Address - Fax:619-266-0496
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical