Provider Demographics
NPI:1619225679
Name:CAMELOT COMMUNITY CARE, INC
Entity Type:Organization
Organization Name:CAMELOT COMMUNITY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:727-692-6682
Mailing Address - Street 1:1412 TECH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7865
Mailing Address - Country:US
Mailing Address - Phone:813-635-9765
Mailing Address - Fax:813-635-9725
Practice Address - Street 1:1412 TECH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-7865
Practice Address - Country:US
Practice Address - Phone:813-635-9765
Practice Address - Fax:813-635-9725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency