Provider Demographics
NPI:1366592057
Name:CLEMENSON, JANET E (LCSW)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:E
Last Name:CLEMENSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 BROADWAY ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5564
Mailing Address - Country:US
Mailing Address - Phone:877-319-1579
Mailing Address - Fax:281-485-9863
Practice Address - Street 1:2006 BROADWAY ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5564
Practice Address - Country:US
Practice Address - Phone:877-319-1579
Practice Address - Fax:281-485-9863
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0058NUMedicare UPIN