Healthcare Provider Details

I. General information

NPI: 1043568371
Provider Name (Legal Business Name): CAMELOT COMMUNITY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 CREEKSIDE DR SUITE D
CLEARWATER FL
33760-4023
US

IV. Provider business mailing address

4910 CREEKSIDE DR. SUITE D
CLEARWATER FL
33760
US

V. Phone/Fax

Practice location:
  • Phone: 727-593-0003
  • Fax: 727-596-1713
Mailing address:
  • Phone: 727-593-0003
  • Fax: 727-596-1713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JULIE WLADAVER
Title or Position: THERAPIST
Credential: MS
Phone: 727-593-0003