Provider Demographics
NPI:1356434690
Name:PARKER, CAMILLE IRENE (LICPSYCH-MASTER)
Entity type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:IRENE
Last Name:PARKER
Suffix:
Gender:F
Credentials:LICPSYCH-MASTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROCK DR
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:VT
Mailing Address - Zip Code:05149-1322
Mailing Address - Country:US
Mailing Address - Phone:802-228-7967
Mailing Address - Fax:
Practice Address - Street 1:1462 GREEN MOUNTAIN TPKE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VT
Practice Address - Zip Code:05143-8874
Practice Address - Country:US
Practice Address - Phone:802-875-2672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000601103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1004750Medicaid