Provider Demographics
NPI:1023387065
Name:MARMOLEJO, CAMILO E (MA, LPC, CSC, NCC)
Entity Type:Individual
Prefix:MR
First Name:CAMILO
Middle Name:E
Last Name:MARMOLEJO
Suffix:
Gender:M
Credentials:MA, LPC, CSC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 RIDGE RD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-6357
Mailing Address - Country:US
Mailing Address - Phone:201-998-5386
Mailing Address - Fax:
Practice Address - Street 1:108 RIDGE RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NORTH ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07031-6357
Practice Address - Country:US
Practice Address - Phone:201-998-5386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ809351101YS0200X
NJ37PC00520400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0020524Medicaid