Provider Demographics
NPI:1558676213
Name:CAMACHO, GLENDA Y
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:Y
Last Name:CAMACHO
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:HC 1 BOX 6132
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-9707
Mailing Address - Country:US
Mailing Address - Phone:939-247-6112
Mailing Address - Fax:787-844-4130
Practice Address - Street 1:HC 1 BOX 6132
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-9707
Practice Address - Country:US
Practice Address - Phone:939-247-6112
Practice Address - Fax:787-844-4130
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)