Provider Demographics
NPI:1689969941
Name:CAMMARANO, KIMBERLY ANGELA
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANGELA
Last Name:CAMMARANO
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 1:2470 BLOOMINGDALE AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6403
Mailing Address - Country:US
Mailing Address - Phone:727-586-8800
Mailing Address - Fax:727-605-6213
Practice Address - Street 1:2470 BLOOMINGDALE AVE STE 220
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6403
Practice Address - Country:US
Practice Address - Phone:727-586-8800
Practice Address - Fax:727-605-6213
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health