Provider Demographics
NPI:1336703131
Name:CAMPS, CORALYZ (TS)
Entity Type:Individual
Prefix:MRS
First Name:CORALYZ
Middle Name:
Last Name:CAMPS
Suffix:
Gender:F
Credentials:TS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE MARCELITO GOTAY
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-852-1400
Mailing Address - Fax:787-801-2900
Practice Address - Street 1:E52 C DONCELLA
Practice Address - Street 2:URB PARQUE CANDELERO
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-7601
Practice Address - Country:US
Practice Address - Phone:787-405-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7427104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker