Provider Demographics
NPI:1366455776
Name:VOZAR, CAMILLE A (MSW)
Entity type:Individual
Prefix:MR
First Name:CAMILLE
Middle Name:A
Last Name:VOZAR
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 PAULINE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5036
Mailing Address - Country:US
Mailing Address - Phone:734-747-9073
Mailing Address - Fax:734-747-9073
Practice Address - Street 1:1905 PAULINE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5036
Practice Address - Country:US
Practice Address - Phone:734-747-9073
Practice Address - Fax:734-747-9073
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801011181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP20960Medicare ID - Type UnspecifiedMEDICARE PART B