Provider Demographics
NPI:1598405425
Name:MCDONALD MORANZ, CAMELE ANTONETTE
Entity Type:Individual
Prefix:MRS
First Name:CAMELE
Middle Name:ANTONETTE
Last Name:MCDONALD MORANZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7075 N HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-5216
Mailing Address - Country:US
Mailing Address - Phone:321-888-3020
Mailing Address - Fax:661-263-4584
Practice Address - Street 1:1737 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5533
Practice Address - Country:US
Practice Address - Phone:321-888-3020
Practice Address - Fax:661-263-4584
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-218871106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician