Provider Demographics
NPI:1518241173
Name:CAMARENA, JUDY ANGELICA (LMFT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ANGELICA
Last Name:CAMARENA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12821 NEWPORT AVE.
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:949-505-9944
Mailing Address - Fax:800-785-4399
Practice Address - Street 1:12821 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:949-505-9944
Practice Address - Fax:714-333-4840
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48066106H00000X
CALMFT48066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist