Camille Black, | |
5284 Adolfo Rd, Camarillo, CA 93012-6787 | |
(805) 289-0120 | |
Not Available |
Full Name | Camille Black |
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Gender | Female |
Speciality | Marriage & Family Therapist |
Location | 5284 Adolfo Rd, Camarillo, California |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1083137467 | NPI | - | NPPES |
56CC | Other | CA | ASPIRANET |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
106H00000X | Marriage & Family Therapist | 97114 (California) | Secondary |
106H00000X | Marriage & Family Therapist | 127823 (California) | Primary |
Entity Name | Southern California Permanente Medical Group |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1770515280 PECOS PAC ID: 6002729175 Enrollment ID: O20031110000678 |
Mailing Address | Practice Location Address |
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Camille Black, Po Box 19153, Newbury Park, CA 91319-9153 Ph: (805) 795-0987 | Camille Black, 5284 Adolfo Rd, Camarillo, CA 93012-6787 Ph: (805) 289-0120 |
Martha S. Allen-miles, MFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 975 Flynn Rd, Camarillo, CA 93012 Phone: 805-388-7740 Fax: 805-482-0987 | |
Michelle Christine Wonders, M.S.,M.F.T. Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 5301 Mission Oaks Blvd, Suite C, Camarillo, CA 93012 Phone: 805-482-7724 | |
Mr. Raphael Clemente Serrano, LMFT LICENSED MARRIG Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 401 Mobil Ave, Suite 8, Camarillo, CA 93010 Phone: 805-448-7732 Fax: 805-482-3762 | |
Lisa Grace Polisano, Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 975 Flynn Rd, Camarillo, CA 93012 Phone: 805-914-1439 Fax: 805-482-0987 | |
Ms. Deanna Lyn Grove, M.S. Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 1305 Del Norte Road, Suite 130, Camarillo, CA 93010 Phone: 805-485-6114 | |
Mrs. Nancy Jeanne Bates, M.S.,MFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 484 Mobil Ave, Suite 13, Camarillo, CA 93010 Phone: 805-279-1996 | |
Anna B Alcala, M.S., LMFT#84636 Couples Therapy Medicare: Medicare Enrolled Practice Location: 155 Granada St Ste I, Camarillo, CA 93010 Phone: 805-628-2204 |