Provider Demographics
NPI:1144682907
Name:CLEMENTS, RICHARD S (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:S
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:STONE HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08247-0191
Mailing Address - Country:US
Mailing Address - Phone:732-213-4690
Mailing Address - Fax:
Practice Address - Street 1:176 DARBY LN
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-1485
Practice Address - Country:US
Practice Address - Phone:732-213-4690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00473700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional