Provider Demographics
NPI:1629119235
Name:CENEDELLA, CAMILLA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:CAMILLA
Middle Name:ANN
Last Name:CENEDELLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAMILLA
Other - Middle Name:ANN
Other - Last Name:KUTCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5251 E ALHAMBRA PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1306
Mailing Address - Country:US
Mailing Address - Phone:520-326-5626
Mailing Address - Fax:
Practice Address - Street 1:1010 E 10TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5813
Practice Address - Country:US
Practice Address - Phone:520-326-5626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-0982104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ584880Medicaid