Individual provider Active NPI

Cierra Nicole Camon, MSW

  • Mental Health Counselor
  • N Ft Myers, FL
National Provider Identifier
1366095499
Registry record updated Jul 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
390 Pondella Rd Ste 9
N Ft Myers, FL 33903-4340
Phone
(239) 652-0260
Fax
(239) 652-0146
NPI assigned
Jul 17, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 17, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

390 Pondella Rd Ste 9
N Ft Myers, FL 33903-4340

Mailing address

12505 McGregor Blvd Apt 211
Fort Myers, FL 33919-3185
Phone (941) 676-2821

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Direct Access Counseling & Supportive Services, LLC Mental Health CurrentSince Jul 25, 2019 Accepting new patients
Ultima Rehab-FL LLC CurrentSince Jul 25, 2019 Accepting new patients

Locations

390 Pondella Rd
Ste 9
North Ft Myers, FL 33903
Phone (239) 652-0260

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563321600000",
    "number": "1366095499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12505 MCGREGOR BLVD APT 211",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339193185",
            "telephone_number": "941-676-2821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "390 PONDELLA RD STE 9",
            "city": "N FT MYERS",
            "state": "FL",
            "postal_code": "339034340",
            "telephone_number": "239-652-0260",
            "fax_number": "239-652-0146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMON",
        "first_name": "CIERRA",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-17",
        "last_updated": "2019-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in N Ft Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.