Provider Demographics
NPI:1376083253
Name:CAMACHO, HANNAH SOPHIA
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:SOPHIA
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4105
Mailing Address - Country:US
Mailing Address - Phone:407-205-7794
Mailing Address - Fax:
Practice Address - Street 1:151 W CHURCH AVE
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4105
Practice Address - Country:US
Practice Address - Phone:407-205-7794
Practice Address - Fax:888-808-5278
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician