Provider Demographics
NPI:1497984728
Name:SOUCY-CAMIRE, JOHANNE (MED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNE
Middle Name:
Last Name:SOUCY-CAMIRE
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MACINTOSH LN
Mailing Address - Street 2:
Mailing Address - City:OLD ORCHARD BEACH
Mailing Address - State:ME
Mailing Address - Zip Code:04064-1477
Mailing Address - Country:US
Mailing Address - Phone:207-937-2103
Mailing Address - Fax:
Practice Address - Street 1:15 MACINTOSH LN
Practice Address - Street 2:
Practice Address - City:OLD ORCHARD BEACH
Practice Address - State:ME
Practice Address - Zip Code:04064-1477
Practice Address - Country:US
Practice Address - Phone:207-937-2103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1-09-5152103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst