Provider Demographics
NPI:1619503489
Name:KEEFE, CAMILLE ELISE (MSW)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:ELISE
Last Name:KEEFE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:ELISE
Other - Last Name:DANON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 VALLEY MALL WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-5462
Mailing Address - Country:US
Mailing Address - Phone:360-428-1301
Mailing Address - Fax:360-428-1302
Practice Address - Street 1:301 VALLEY MALL WAY STE 100
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5462
Practice Address - Country:US
Practice Address - Phone:360-428-1301
Practice Address - Fax:360-428-1302
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61041628101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health