Provider Demographics
NPI:1487820171
Name:HERNANDEZ, CAMILLE ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:ANN
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2951
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85232-2951
Mailing Address - Country:US
Mailing Address - Phone:480-208-3375
Mailing Address - Fax:480-706-9449
Practice Address - Street 1:65 EAST RUGGLES RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85232-2951
Practice Address - Country:US
Practice Address - Phone:480-310-8555
Practice Address - Fax:480-706-9449
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3939103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist