MEDICARE: CLEMENTINE PSYCHIATRY

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1285590117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEMENTINE PSYCHIATRY

Provider Business Mailing Address
First Line	:	27700 FAIRMOUNT BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44124-4612
Country	:	US
Telephone Number	:	216-208-5884
Fax Number	:	216-250-9611

Provider Business Practice Location Address
First Line	:	27700 FAIRMOUNT BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44124-4612
Country	:	US
Telephone Number	:	216-208-5884
Fax Number	:	216-250-9611

Authorized Official
Title or Position	:	OWNER
Name	:	NICOLE NEALE
Credential	:
Telephone Number	:	216-208-5884

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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Directions to “CLEMENTINE PSYCHIATRY ” Practice Location

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