Provider Demographics
NPI:1104133479
Name:EXCONDE-TRINIDAD, CAMILLE B (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:B
Last Name:EXCONDE-TRINIDAD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 MCDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5512
Mailing Address - Country:US
Mailing Address - Phone:718-375-8885
Mailing Address - Fax:718-375-8886
Practice Address - Street 1:1575 MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5512
Practice Address - Country:US
Practice Address - Phone:718-375-8885
Practice Address - Fax:718-375-8886
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019609-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist