Provider Demographics
NPI:1407318900
Name:ANGWENYI, CAMILE OGAMBA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:CAMILE
Middle Name:OGAMBA
Last Name:ANGWENYI
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 S ST ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3844
Mailing Address - Country:US
Mailing Address - Phone:386-254-8788
Mailing Address - Fax:386-226-2076
Practice Address - Street 1:77 S ST ANDREWS DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3844
Practice Address - Country:US
Practice Address - Phone:386-254-8788
Practice Address - Fax:386-226-2076
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-14-16009103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019124900Medicaid