MEDICARE: MS. CIERRA NICOLE CAMON MSW

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1366095499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CIERRA NICOLE CAMON MSW

Provider Business Mailing Address
First Line	:	12505 MCGREGOR BLVD APT 211
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3185
Country	:	US
Telephone Number	:	941-676-2821
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 PONDELLA RD STE 9
Second Line	:
City	:	N FT MYERS
State	:	FL
Zip	:	33903-4340
Country	:	US
Telephone Number	:	239-652-0260
Fax Number	:	239-652-0146

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

Provider Enumeration Date	:	07/17/2019
Last Update Date	:	07/17/2019

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