MEDICARE: MIMI K CAMARATA LCSW

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	1041C0700X	Clinical Social Worker	C10952	MS

General Provider Information

NPI Number	:	1316031214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIMI K CAMARATA LCSW

Provider Business Mailing Address
First Line	:	3606 MAGNOLIA ST
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39563-5137
Country	:	US
Telephone Number	:	228-369-7968
Fax Number	:

Provider Business Practice Location Address
First Line	:	3606 MAGNOLIA ST
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39563-5137
Country	:	US
Telephone Number	:	228-369-7968
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	11/14/2025

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