Provider Demographics
NPI:1871657809
Name:CAMREN, FONDA LEIGH (LBSW)
Entity Type:Individual
Prefix:MS
First Name:FONDA
Middle Name:LEIGH
Last Name:CAMREN
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5212
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78465-5212
Mailing Address - Country:US
Mailing Address - Phone:361-332-8307
Mailing Address - Fax:
Practice Address - Street 1:2931 LOVERS LN
Practice Address - Street 2:
Practice Address - City:INGLESIDE
Practice Address - State:TX
Practice Address - Zip Code:78362-4029
Practice Address - Country:US
Practice Address - Phone:361-332-8307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27295171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator