Provider Demographics
NPI:1578973335
Name:DELEONARDIS, CAMILLE ASHLEY (PSYD)
Entity type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:ASHLEY
Last Name:DELEONARDIS
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CAMILLE
Other - Middle Name:ASHLEY
Other - Last Name:MALCHERCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:3206 LONGMIRE DR STE A15
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5858
Mailing Address - Country:US
Mailing Address - Phone:979-703-0616
Mailing Address - Fax:979-764-2828
Practice Address - Street 1:3206 LONGMIRE DR STE A15
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5858
Practice Address - Country:US
Practice Address - Phone:979-703-0616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39106103TC0700X, 103TC0700X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01536011OtherMEDI-CAL