Provider Demographics
NPI:1043568371
Name:CAMELOT COMMUNITY CARE
Entity Type:Organization
Organization Name:CAMELOT COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WLADAVER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:727-593-0003
Mailing Address - Street 1:4910 CREEKSIDE DR.
Mailing Address - Street 2:SUITE D
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760
Mailing Address - Country:US
Mailing Address - Phone:727-593-0003
Mailing Address - Fax:727-596-1713
Practice Address - Street 1:4910 CREEKSIDE DR
Practice Address - Street 2:SUITE D
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-4023
Practice Address - Country:US
Practice Address - Phone:727-593-0003
Practice Address - Fax:727-596-1713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health