Provider Demographics
NPI:1336421353
Name:FINE, CAMILLE T (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:T
Last Name:FINE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13575 58TH ST N
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3740
Mailing Address - Country:US
Mailing Address - Phone:727-742-7319
Mailing Address - Fax:
Practice Address - Street 1:13575 58TH ST N
Practice Address - Street 2:SUITE 107
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3740
Practice Address - Country:US
Practice Address - Phone:727-742-7319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5786103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent