MEDICARE: DIANA CLEMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1063965838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA CLEMENT

Provider Business Mailing Address
First Line	:	2813 EXECUTIVE PARK DR # 134
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33331-3603
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2813 EXECUTIVE PARK DR # 134
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33331-3603
Country	:	US
Telephone Number	:	954-399-0723
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2016
Last Update Date	:	12/27/2022

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Directions to “ DIANA CLEMENT ” Practice Location

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