Provider Demographics
NPI:1437411147
Name:CIACCI, CAMILLE GUARINO (MS)
Entity Type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:GUARINO
Last Name:CIACCI
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10590-1614
Mailing Address - Country:US
Mailing Address - Phone:914-977-3796
Mailing Address - Fax:
Practice Address - Street 1:161 SPRING ST
Practice Address - Street 2:
Practice Address - City:SOUTH SALEM
Practice Address - State:NY
Practice Address - Zip Code:10590-1614
Practice Address - Country:US
Practice Address - Phone:914-977-3796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1545058174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist