Provider Demographics
NPI:1366691362
Name:CAMACHO, REGINA ELIZA (LCSW)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:ELIZA
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:ELIZA
Other - Last Name:ACOSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:80 GREAT OAKS BLVD
Mailing Address - Street 2:B-502
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119
Mailing Address - Country:US
Mailing Address - Phone:408-363-3000
Mailing Address - Fax:408-363-3046
Practice Address - Street 1:1555 PARKMOOR AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2407
Practice Address - Country:US
Practice Address - Phone:408-282-0402
Practice Address - Fax:408-282-0400
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CALCSW685211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor