MEDICARE: CAMILLE ANNE PHILLIPS

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1558896829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE ANNE PHILLIPS

Provider Business Mailing Address
First Line	:	5951 RIO DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-2922
Country	:	US
Telephone Number	:	727-858-6582
Fax Number	:

Provider Business Practice Location Address
First Line	:	5951 RIO DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-2922
Country	:	US
Telephone Number	:	727-858-6582
Fax Number	:

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

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	04/25/2017

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Directions to “ CAMILLE ANNE PHILLIPS ” Practice Location

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