MEDICARE: CHRISTINA RAFFA CLEMENTS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1003105008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA RAFFA CLEMENTS

Provider Business Mailing Address
First Line	:	2290 N RONALD REAGAN BLVD STE 116
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-3534
Country	:	US
Telephone Number	:	549-281-9959
Fax Number	:

Provider Business Practice Location Address
First Line	:	5436 NW MOORHEN TRL
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-4322
Country	:	US
Telephone Number	:	772-924-4707
Fax Number	:

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

Provider Enumeration Date	:	03/31/2011
Last Update Date	:	04/18/2023

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