Provider Demographics
NPI:1417411265
Name:CAMELO, LUIZA NAVARRO
Entity Type:Individual
Prefix:
First Name:LUIZA
Middle Name:NAVARRO
Last Name:CAMELO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUIZA
Other - Middle Name:JOHN IVO
Other - Last Name:NAVARRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:334 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-2616
Mailing Address - Country:US
Mailing Address - Phone:774-545-5057
Mailing Address - Fax:
Practice Address - Street 1:80 ERDMAN WAY STE 208
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1840
Practice Address - Country:US
Practice Address - Phone:978-870-1840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health