Provider Demographics
NPI:1598230153
Name:YOUNG, CAMILO ANTONIO I
Entity Type:Individual
Prefix:
First Name:CAMILO
Middle Name:ANTONIO
Last Name:YOUNG
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CLARKE SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6021
Mailing Address - Country:US
Mailing Address - Phone:800-668-5614
Mailing Address - Fax:
Practice Address - Street 1:1815 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CLARKE SHORES
Practice Address - State:FL
Practice Address - Zip Code:33406-6021
Practice Address - Country:US
Practice Address - Phone:800-668-5614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst