Individual
DR. CAROL HART CLEMENKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
4096 PARK BLVD., SUITE C, SAN DIEGO, CA 92103-2620
(619) 260-0865
(619) 260-0640
Mailing address
4096 PARK BLVD., SUITE C, SAN DIEGO, CA 92103-2620
(619) 260-0865
(619) 260-0640
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY8757
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PSY8757
LICENSE
CA
Enumeration date
07/03/2006
Last updated
07/08/2007
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