Provider Demographics
NPI:1912470899
Name:DECAMPS, MASSIEL (PSYD)
Entity Type:Individual
Prefix:
First Name:MASSIEL
Middle Name:
Last Name:DECAMPS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 BANKS ROSE CT
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4834
Mailing Address - Country:US
Mailing Address - Phone:917-561-6471
Mailing Address - Fax:
Practice Address - Street 1:1110 BANKS ROSE CT
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4834
Practice Address - Country:US
Practice Address - Phone:917-561-6471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1376103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool