Provider Demographics
NPI:1326269416
Name:CARCAMO, JAIME H (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:H
Last Name:CARCAMO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4322 50TH ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4442
Mailing Address - Country:US
Mailing Address - Phone:718-424-9292
Mailing Address - Fax:718-424-6199
Practice Address - Street 1:4322 50TH ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4442
Practice Address - Country:US
Practice Address - Phone:718-424-9292
Practice Address - Fax:718-424-6199
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014573103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical