Provider Demographics
NPI:1508515438
Name:BORGES CAMEJO, SUSAN LILIAM
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LILIAM
Last Name:BORGES CAMEJO
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 1:9631 FONTAINEBLEAU BLVD APT 301
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-6860
Mailing Address - Country:US
Mailing Address - Phone:305-910-1998
Mailing Address - Fax:
Practice Address - Street 1:9631 FONTAINEBLEAU BLVD APT 301
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-6860
Practice Address - Country:US
Practice Address - Phone:305-910-1998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-19
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-205668106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician