Provider Demographics
NPI:1891353165
Name:RICHARDVILLE, CAMRYN
Entity Type:Individual
Prefix:
First Name:CAMRYN
Middle Name:
Last Name:RICHARDVILLE
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 1:411 N DONNELLY ST STE 307
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-5596
Mailing Address - Country:US
Mailing Address - Phone:321-356-8429
Mailing Address - Fax:
Practice Address - Street 1:411 N DONNELLY ST STE 307
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-5596
Practice Address - Country:US
Practice Address - Phone:321-356-8429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician