Provider Demographics
NPI:1700015401
Name:DERRICOTTE, CAMILLE R (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:R
Last Name:DERRICOTTE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2561 E FORT LOWELL RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1540
Mailing Address - Country:US
Mailing Address - Phone:520-260-4997
Mailing Address - Fax:
Practice Address - Street 1:2561 E FORT LOWELL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1540
Practice Address - Country:US
Practice Address - Phone:520-260-4997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ124581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical