Provider Demographics
NPI:1306008354
Name:CAMACHO, CARLOS O (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:O
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CONDOMINIO LOS ROBLES
Mailing Address - Street 2:APARTAMENTO G4-A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-486-5021
Mailing Address - Fax:
Practice Address - Street 1:CONDOMINIO LOS ROBLES
Practice Address - Street 2:APARTAMENTO G4-A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-486-5021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR96361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical