Provider Demographics
NPI:1578502084
Name:CAMMARATA, LARRY (PHD)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:CAMMARATA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OAK PLZ STE 206
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3000
Mailing Address - Country:US
Mailing Address - Phone:828-252-2501
Mailing Address - Fax:828-252-2701
Practice Address - Street 1:1 OAK PLZ STE 206
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3000
Practice Address - Country:US
Practice Address - Phone:828-252-2501
Practice Address - Fax:828-252-2701
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9236103TC0700X
NC3288103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6001151Medicaid
NC6001151Medicaid
CAWCP9236AMedicare PIN
NC2829400Medicare PIN