1962292888 NPI number — MS. CAMILLE MICHELLE BOOTH MSW

Table of content: MS. CAMILLE MICHELLE BOOTH MSW (NPI 1962292888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962292888 NPI number — MS. CAMILLE MICHELLE BOOTH MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOOTH
Provider First Name:
CAMILLE
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962292888
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
217 E MANOR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99501-1149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-617-8424
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SOCIAL SCIENCE BUILDING, ROOM 255E
Provider Second Line Business Practice Location Address:
3211 PROVIDENCE DRIVE
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-4614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-786-1795
Provider Business Practice Location Address Fax Number:
907-786-1790
Provider Enumeration Date:
05/12/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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