Provider Demographics
NPI:1346295169
Name:CAMARENA, CARLOS (LSCSW)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:CAMARENA
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12367 E LINCOLN CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-7005
Mailing Address - Country:US
Mailing Address - Phone:316-734-9568
Mailing Address - Fax:316-854-5285
Practice Address - Street 1:12367 E LINCOLN CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-7005
Practice Address - Country:US
Practice Address - Phone:316-734-9568
Practice Address - Fax:316-854-5285
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1648104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS066242OtherBLUE CROSS BLUE SHIELD
KS066242Medicare ID - Type Unspecified
KS066242OtherBLUE CROSS BLUE SHIELD
KS2144760OtherCIGNA