Mark A Clementi, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY 13898 Issued in CA

Practice address

50 Old Courthouse SQ Ste 400
Santa Rosa, CA 95404-4924

Phone

(707) 527-0456

Fax

(707) 527-1013

NPI assigned

May 19, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242691200000",
    "number": "1245465335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 OLD COURTHOUSE SQ STE 400",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044924",
            "telephone_number": "707-527-0456",
            "fax_number": "707-527-1013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 OLD COURTHOUSE SQ STE 400",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044924",
            "telephone_number": "707-527-0456",
            "fax_number": "707-527-1013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMENTI",
        "first_name": "MARK",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-19",
        "last_updated": "2009-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY 13898",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "CA",
            "license": "PSY 13898",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 13898",
            "primary": true
        },
        {
            "code": "103TE1100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Exercise & Sports",
            "state": "CA",
            "license": "PSY 13898",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Val Clayton
• CLB Associates
• Clear Minds LLC
• Karen Marie Clem, PPS
• Erica Karin Clementi, LCSW
• Ethan Clemmer
• Sophia M Clifford, BA, CADTP
• Jessica Clifton, PH.D.
• Allison Dawn Kemper Cline, B.A.
• Kevin Michael Cline

• Clinical Psychologist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.