Provider Demographics
NPI:1942379326
Name:CAMM, ANNE ELIZABETH (PSYD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:ELIZABETH
Last Name:CAMM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:FIFTH FLOOR
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-2584
Mailing Address - Country:US
Mailing Address - Phone:513-420-5233
Mailing Address - Fax:513-420-8768
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:FIFTH FLOOR
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-2584
Practice Address - Country:US
Practice Address - Phone:513-420-5233
Practice Address - Fax:513-420-8768
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4892103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2211510Medicaid
OHDCN5500000021775083Medicare UPIN
OHCACP 18782Medicare ID - Type UnspecifiedPROVIDERIDENTIFICATIONNUM
OHCP18787Medicare PIN