Provider Demographics
NPI:1043685233
Name:CAMEN BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:CAMEN BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:ALEXIS
Authorized Official - Last Name:LOTTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-972-4039
Mailing Address - Street 1:148 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5372
Mailing Address - Country:US
Mailing Address - Phone:407-687-4439
Mailing Address - Fax:
Practice Address - Street 1:148 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707
Practice Address - Country:US
Practice Address - Phone:407-687-4439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014487800Medicaid
FL017804811Medicaid
FL017804814Medicaid
FL017804807Medicaid