Provider Demographics
NPI:1518299783
Name:CAMACHO, YESENIA (PSYD)
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 14TH ST
Mailing Address - Street 2:APT 2F
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3720
Mailing Address - Country:US
Mailing Address - Phone:215-817-0167
Mailing Address - Fax:
Practice Address - Street 1:2525 14TH ST
Practice Address - Street 2:APT 2F
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3720
Practice Address - Country:US
Practice Address - Phone:215-817-0167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist