MEDICARE: CAMILLE ELIZABETH MYERS PH.D., NCSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY11702	FL

General Provider Information

NPI Number	:	1437860541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE ELIZABETH MYERS PH.D., NCSP

Provider Business Mailing Address
First Line	:	6740 CROSSWINDS DR N STE L
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-8606
Country	:	US
Telephone Number	:	727-599-3624
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 S BOULEVARD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1901
Country	:	US
Telephone Number	:	727-599-3624
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2022
Last Update Date	:	12/09/2022

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