Healthcare Provider Details

I. General information

NPI: 1386586170
Provider Name (Legal Business Name): CHRISTINA MARIE CLEMENTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 SAN SALVADOR DR
BOCA RATON FL
33433-1009
US

IV. Provider business mailing address

4222 S FLORIDA AVE
LAKELAND FL
33813-1628
US

V. Phone/Fax

Practice location:
  • Phone: 305-845-8130
  • Fax:
Mailing address:
  • Phone: 863-456-7148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-541880
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: