MEDICARE: CAMEN BEHAVIORAL SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106E00000X	Assistant Behavior Analyst
2	106S00000X	Behavior Technician
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1457811598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMEN BEHAVIORAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	148 WILSHIRE BLVD
Second Line	:
City	:	CASSELBERRY
State	:	FL
Zip	:	32707-5372
Country	:	US
Telephone Number	:	321-972-4039
Fax Number	:	321-445-9760

Provider Business Practice Location Address
First Line	:	3200 S HIAWASSEE RD STE 203
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-6317
Country	:	US
Telephone Number	:	407-490-1453
Fax Number	:	321-445-9760

Authorized Official
Title or Position	:	OWNER
Name	:	CLAIRE ALEXIS LOTTMAN
Credential	:	BCBA
Telephone Number	:	407-964-1232

Provider Enumeration Date	:	03/24/2019
Last Update Date	:	03/10/2020

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