Provider Demographics
NPI:1366228322
Name:ESTICK, CAMILLE DESRINE
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:DESRINE
Last Name:ESTICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 INVERRARY BLVD STE 408D
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4359
Mailing Address - Country:US
Mailing Address - Phone:321-243-8095
Mailing Address - Fax:
Practice Address - Street 1:3800 INVERRARY BLVD STE 408D
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4359
Practice Address - Country:US
Practice Address - Phone:321-243-8095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services