Provider Demographics
NPI:1417385956
Name:CAMMARATA, VICTORIA (LMSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:CAMMARATA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1131
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-1131
Mailing Address - Country:US
Mailing Address - Phone:231-935-5085
Mailing Address - Fax:231-392-0334
Practice Address - Street 1:1221 SIXTH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2701
Practice Address - Country:US
Practice Address - Phone:231-935-5085
Practice Address - Fax:231-392-0334
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL24238861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical