Provider Demographics
NPI:1740015718
Name:CAMERON, LAURA
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:CAMERON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:EGOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6817 8TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-6815
Mailing Address - Country:US
Mailing Address - Phone:727-644-3472
Mailing Address - Fax:
Practice Address - Street 1:2685 ULMERTON RD STE 201
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-5330
Practice Address - Country:US
Practice Address - Phone:727-851-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-07
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician