Healthcare Provider Details

I. General information

NPI: 1104350107
Provider Name (Legal Business Name): MISS AMY MARIE CAMADECO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 W CHARLESTON #140
LAS VEGAS NV
89146
US

IV. Provider business mailing address

520 COLLEGE DR APT 413
HENDERSON NV
89015-7585
US

V. Phone/Fax

Practice location:
  • Phone: 702-437-4673
  • Fax: 702-438-4673
Mailing address:
  • Phone: 702-466-3895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: