Basic Information
Provider Information
NPI: 1659708782
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORGANTE
FirstName: CAMDEN
MiddleName: ANNE
NamePrefix: DR.
NameSuffix:  
Credential: PSY.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6350 W ANDREW JOHNSON HWY
Address2: DEPARTMENT 100
City: TALBOTT
State: TN
PostalCode: 378778605
CountryCode: US
TelephoneNumber: 8003553565
FaxNumber: 4237142355
Practice Location
Address1: 501 ADESSA PKWY
Address2: SUITE A-150
City: LENOIR CITY
State: TN
PostalCode: 377716725
CountryCode: US
TelephoneNumber: 8659868082
FaxNumber: 8659865890
Other Information
ProviderEnumerationDate: 10/03/2013
LastUpdateDate: 09/11/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X  N Behavioral Health & Social Service ProvidersPsychologist 
103TC0700XP3180TNY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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