MEDICARE: STEPHANIE MARIE CLEMENTE 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	1-24-75246	SC

General Provider Information

NPI Number	:	1720651722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MARIE CLEMENTE BCBA

Provider Business Mailing Address
First Line	:	885 GOLD HILL RD # 3104
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-7946
Country	:	US
Telephone Number	:	803-902-5943
Fax Number	:	803-675-0443

Provider Business Practice Location Address
First Line	:	885 GOLD HILL RD # 3104
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-7946
Country	:	US
Telephone Number	:	803-902-5943
Fax Number	:	803-675-0443

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

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	02/02/2026

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