Provider Demographics
NPI:1699867887
Name:CLEMONS, VALERIE A (MD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:A
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1445
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-1445
Mailing Address - Country:US
Mailing Address - Phone:207-975-2078
Mailing Address - Fax:207-594-8054
Practice Address - Street 1:21 ELM ST FL 3
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-1902
Practice Address - Country:US
Practice Address - Phone:207-975-2078
Practice Address - Fax:207-236-3040
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0155102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME104000000Medicaid
MEMM8192Medicare PIN
ME104000000Medicaid