Provider Demographics
NPI:1407410590
Name:CLEMONS, BRIONNE CARYN
Entity type:Individual
Prefix:
First Name:BRIONNE
Middle Name:CARYN
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 N CLIVEDEN AVE
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-1619
Mailing Address - Country:US
Mailing Address - Phone:323-234-4445
Mailing Address - Fax:
Practice Address - Street 1:5201 GREAT AMERICA PKWY STE 320
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1140
Practice Address - Country:US
Practice Address - Phone:323-205-7088
Practice Address - Fax:866-280-0260
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97170101YM0800X
CA1260301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health