Provider Demographics
NPI:1043393036
Name:DEORIO, CAMILLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:
Last Name:DEORIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3422
Mailing Address - Country:US
Mailing Address - Phone:516-358-0533
Mailing Address - Fax:
Practice Address - Street 1:87 COVERT AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3219
Practice Address - Country:US
Practice Address - Phone:516-354-1409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041286-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN70861Medicare ID - Type Unspecified