Provider Demographics
NPI:1558459784
Name:CAMILLE, ANAEL LUC (LCSW)
Entity Type:Individual
Prefix:
First Name:ANAEL
Middle Name:LUC
Last Name:CAMILLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19154 115TH RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2708
Mailing Address - Country:US
Mailing Address - Phone:718-769-0405
Mailing Address - Fax:718-769-0419
Practice Address - Street 1:19154 115TH RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2708
Practice Address - Country:US
Practice Address - Phone:718-769-0405
Practice Address - Fax:718-769-0419
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical