Provider Demographics
NPI:1376880740
Name:EVERSLEY, CAMILLE JOY (LMSW)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:JOY
Last Name:EVERSLEY
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 1:749 MARCY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1219
Mailing Address - Country:US
Mailing Address - Phone:347-351-3729
Mailing Address - Fax:347-715-2661
Practice Address - Street 1:749 MARCY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-1219
Practice Address - Country:US
Practice Address - Phone:347-351-3729
Practice Address - Fax:347-715-2661
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-05
Last Update Date:2013-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7939611104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker