Provider Demographics
NPI:1508395864
Name:CAMP, CHERYL ROXANN
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ROXANN
Last Name:CAMP
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 1:530 E 169TH ST APT 10E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-2671
Mailing Address - Country:US
Mailing Address - Phone:646-327-3312
Mailing Address - Fax:718-293-0254
Practice Address - Street 1:530 EAST 169TH STREET
Practice Address - Street 2:APT. 10E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456
Practice Address - Country:US
Practice Address - Phone:646-327-3312
Practice Address - Fax:718-293-0254
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty