Provider Demographics
NPI:1730769365
Name:AVERY, CLAIRE DEDE (PHD)
Entity type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:DEDE
Last Name:AVERY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:DEDE
Other - Last Name:GANDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2181 ORANGE AVE E
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-6144
Mailing Address - Country:US
Mailing Address - Phone:850-284-9354
Mailing Address - Fax:
Practice Address - Street 1:2181 ORANGE AVE E
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-6144
Practice Address - Country:US
Practice Address - Phone:850-513-7058
Practice Address - Fax:850-513-8003
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
FLPY10230103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist