Provider Demographics
NPI:1497164925
Name:SMITH, CAMILLE GOETHE (MSW)
Entity type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:GOETHE
Last Name:SMITH
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 OSPREY PT
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32409-2129
Mailing Address - Country:US
Mailing Address - Phone:850-445-1031
Mailing Address - Fax:850-248-2469
Practice Address - Street 1:4102 W HIGHWAY 390
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-4580
Practice Address - Country:US
Practice Address - Phone:850-624-0584
Practice Address - Fax:850-248-2469
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW238071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical