Healthcare Provider Details

I. General information

NPI: 1730854373
Provider Name (Legal Business Name): CAMEN BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 WILSHIRE BLVD
CASSELBERRY FL
32707-5372
US

IV. Provider business mailing address

148 WILSHIRE BLVD
CASSELBERRY FL
32707-5372
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-4039
  • Fax: 321-445-9760
Mailing address:
  • Phone: 321-972-4039
  • Fax: 321-445-9760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: CLAIRE ALEXIS RICH LOTTMAN
Title or Position: CEO
Credential: BCBA
Phone: 321-972-4039