Provider Demographics
NPI:1689276917
Name:CAMILLI, LAURIE ANNE (LICSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANNE
Last Name:CAMILLI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19560 SILVER LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55331-8127
Mailing Address - Country:US
Mailing Address - Phone:612-382-3860
Mailing Address - Fax:
Practice Address - Street 1:7975 STONE CREEK DR STE 130
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4728
Practice Address - Country:US
Practice Address - Phone:952-544-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical