Provider Demographics
NPI:1174999379
Name:SOARES, CAMILLEKAY A (BA)
Entity type:Individual
Prefix:MRS
First Name:CAMILLEKAY
Middle Name:A
Last Name:SOARES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 HEALY AVE
Mailing Address - Street 2:1
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1809
Mailing Address - Country:US
Mailing Address - Phone:212-470-3250
Mailing Address - Fax:
Practice Address - Street 1:2924 HEALY AVE
Practice Address - Street 2:1
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1809
Practice Address - Country:US
Practice Address - Phone:212-470-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator