MEDICARE: STEPHANIE CLEMENS MA, BCBA

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	103K00000X	Behavior Analyst	466	NC

General Provider Information

NPI Number	:	1043509458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE CLEMENS MA, BCBA

Provider Business Mailing Address
First Line	:	526 ASHWORTH RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1212
Country	:	US
Telephone Number	:	201-889-6299
Fax Number	:

Provider Business Practice Location Address
First Line	:	3820 RANDOLPH HEIGHTS DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-7566
Country	:	US
Telephone Number	:	201-889-6299
Fax Number	:

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

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	04/09/2024

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