Provider Demographics
NPI:1528332392
Name:CLEM, JOSEPH PAUL (MA, LMFT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PAUL
Last Name:CLEM
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 PATTON PL
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3758
Mailing Address - Country:US
Mailing Address - Phone:716-860-9178
Mailing Address - Fax:
Practice Address - Street 1:5144 SHERIDAN DR STE 1
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4653
Practice Address - Country:US
Practice Address - Phone:716-860-9178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-26
Last Update Date:2012-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000774-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist