MEDICARE: DR. CAMILLE ASHLEY DELEONARDIS PSYD

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	103TC0700X	Clinical Psychologist	39106	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01536011	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1578973335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAMILLE ASHLEY DELEONARDIS PSYD

Provider Business Mailing Address
First Line	:	3206 LONGMIRE DR STE A15
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-5858
Country	:	US
Telephone Number	:	979-703-0616
Fax Number	:	979-764-2828

Provider Business Practice Location Address
First Line	:	3206 LONGMIRE DR STE A15
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-5858
Country	:	US
Telephone Number	:	979-703-0616
Fax Number	:

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

Provider Enumeration Date	:	05/02/2014
Last Update Date	:	07/17/2025

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