Provider Demographics
NPI:1770099830
Name:MAMARIL, CHRISTEL JANINE CAMPOY
Entity type:Individual
Prefix:
First Name:CHRISTEL JANINE
Middle Name:CAMPOY
Last Name:MAMARIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4058 13TH ST # 1063
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6775
Mailing Address - Country:US
Mailing Address - Phone:321-443-0423
Mailing Address - Fax:
Practice Address - Street 1:4058 13TH ST # 1063
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6775
Practice Address - Country:US
Practice Address - Phone:321-443-0423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22216101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health