Healthcare Provider Details

I. General information

NPI: 1578502084
Provider Name (Legal Business Name): LARRY CAMMARATA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OAK PLZ STE 206
ASHEVILLE NC
28801-3000
US

IV. Provider business mailing address

1 OAK PLZ STE 206
ASHEVILLE NC
28801-3000
US

V. Phone/Fax

Practice location:
  • Phone: 828-252-2501
  • Fax: 828-252-2701
Mailing address:
  • Phone: 828-252-2501
  • Fax: 828-252-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY9236
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3288
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: