Provider Demographics
NPI:1114318912
Name:CAMACHO, GEMMA (MA)
Entity Type:Individual
Prefix:
First Name:GEMMA
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8708 JUSTICE AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4576
Mailing Address - Country:US
Mailing Address - Phone:718-672-1538
Mailing Address - Fax:
Practice Address - Street 1:8708 JUSTICE AVE APT 1F
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4576
Practice Address - Country:US
Practice Address - Phone:718-672-1538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-15
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18 005515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health