MEDICARE: CAMILLE PAULY B.S., BCABA

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	103K00000X	Behavior Analyst	0135652	FL

General Provider Information

NPI Number	:	1609292499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE PAULY B.S., BCABA

Provider Business Mailing Address
First Line	:	2035 SW 75TH ST
Second Line	:	SUITE B
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-3425
Country	:	US
Telephone Number	:	877-823-4383
Fax Number	:

Provider Business Practice Location Address
First Line	:	2035 SW 75TH ST
Second Line	:	SUITE B
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-3425
Country	:	US
Telephone Number	:	877-823-4383
Fax Number	:

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

Provider Enumeration Date	:	03/17/2014
Last Update Date	:	03/17/2014

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