Provider Demographics
NPI:1669879334
Name:SHOTWELL, CASANDRA CAMACHO (PHD)
Entity type:Individual
Prefix:DR
First Name:CASANDRA
Middle Name:CAMACHO
Last Name:SHOTWELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CASANDRA
Other - Middle Name:
Other - Last Name:CAMACHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:751 LOMBARDI CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-6798
Mailing Address - Country:US
Mailing Address - Phone:858-232-5784
Mailing Address - Fax:
Practice Address - Street 1:751 LOMBARDI CT
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-6798
Practice Address - Country:US
Practice Address - Phone:858-232-5784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist