Provider Demographics
NPI:1689018012
Name:GRAU, CAMELLA LIBERTO
Entity Type:Individual
Prefix:
First Name:CAMELLA
Middle Name:LIBERTO
Last Name:GRAU
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 1:6408 BERTHA DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-2248
Mailing Address - Country:US
Mailing Address - Phone:214-499-4220
Mailing Address - Fax:
Practice Address - Street 1:6408 BERTHA DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-2248
Practice Address - Country:US
Practice Address - Phone:214-499-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional