Provider Demographics
NPI:1235582776
Name:BOHANNON-SWEITZER, CAMILLE MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:MARIE
Last Name:BOHANNON-SWEITZER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1453 WILKES WAY SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-0992
Mailing Address - Country:US
Mailing Address - Phone:505-449-7130
Mailing Address - Fax:505-332-8819
Practice Address - Street 1:1453 WILKES WAY SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-0992
Practice Address - Country:US
Practice Address - Phone:505-449-7130
Practice Address - Fax:505-332-8819
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-07404104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker