Provider Demographics
NPI:1518416346
Name:CAMPO, MILIMAR (BCBA)
Entity Type:Individual
Prefix:MS
First Name:MILIMAR
Middle Name:
Last Name:CAMPO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:MILIMAR
Other - Middle Name:
Other - Last Name:CAMPO-JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:JJ11 AVENIDA TENIENTE NELSON MARTINEZ
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-455-8187
Mailing Address - Fax:
Practice Address - Street 1:JJ11 AVENIDA TENIENTE NELSON MARTINEZ
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-455-8187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5649103T00000X
1-22-62107103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist