Provider Demographics
NPI:1639427958
Name:CAMILLE BUSSOTTI PH.D.,LLC
Entity Type:Organization
Organization Name:CAMILLE BUSSOTTI PH.D.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSSOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:941-350-2247
Mailing Address - Street 1:2175 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 75
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9696
Mailing Address - Country:US
Mailing Address - Phone:941-350-2247
Mailing Address - Fax:941-924-7707
Practice Address - Street 1:2175 S TAMIAMI TRL
Practice Address - Street 2:SUITE 75
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9696
Practice Address - Country:US
Practice Address - Phone:941-350-2247
Practice Address - Fax:941-924-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL12000075656103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty