Provider Demographics
NPI:1578634036
Name:CAMERIS, MARY EILEEN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:EILEEN
Last Name:CAMERIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7774 S CANTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8261
Mailing Address - Country:US
Mailing Address - Phone:918-488-8454
Mailing Address - Fax:918-488-8118
Practice Address - Street 1:5525 E. 51ST
Practice Address - Street 2:SUITE 215
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7818
Practice Address - Country:US
Practice Address - Phone:918-488-8454
Practice Address - Fax:918-488-8118
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1578634036OtherCLINICAL SOCIAL WORKER