Provider Demographics
NPI:1578173845
Name:MOORE, CAMRY PATRICE (MSW, RSCWI)
Entity Type:Individual
Prefix:
First Name:CAMRY
Middle Name:PATRICE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSW, RSCWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 VIA DE FOSSI
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8242
Mailing Address - Country:US
Mailing Address - Phone:813-447-3083
Mailing Address - Fax:
Practice Address - Street 1:3309 NORTHLAKE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1705
Practice Address - Country:US
Practice Address - Phone:855-874-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW14839101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional