Provider Demographics
NPI:1720548860
Name:CAMEN BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:CAMEN BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:ALEXIS
Authorized Official - Last Name:LOTTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:321-972-4039
Mailing Address - Street 1:148 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5372
Mailing Address - Country:US
Mailing Address - Phone:321-972-4039
Mailing Address - Fax:321-445-9760
Practice Address - Street 1:4670 CECILE DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-5701
Practice Address - Country:US
Practice Address - Phone:407-978-6085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMEN BEHAVIORAL SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-24
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017804811Medicaid