Provider Demographics
NPI:1528586708
Name:CAMEJO, GENESIS (RBT)
Entity Type:Individual
Prefix:
First Name:GENESIS
Middle Name:
Last Name:CAMEJO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 W 42ND PL APT D
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7605
Mailing Address - Country:US
Mailing Address - Phone:305-432-7399
Mailing Address - Fax:
Practice Address - Street 1:1540 W 42ND PL APT D
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7605
Practice Address - Country:US
Practice Address - Phone:305-432-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL594718554Medicaid