Provider Demographics
NPI:1952758377
Name:SIMONETTI, CAMILLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:
Last Name:SIMONETTI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MISTY MEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9578
Mailing Address - Country:US
Mailing Address - Phone:585-425-7449
Mailing Address - Fax:
Practice Address - Street 1:141 SULLYS TRL
Practice Address - Street 2:SUITE #7B
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-4563
Practice Address - Country:US
Practice Address - Phone:585-204-7061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021360103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling