Provider Demographics
NPI:1568247385
Name:CAMPOS RUESGA, MARICARMEN (CBHCM)
Entity Type:Individual
Prefix:
First Name:MARICARMEN
Middle Name:
Last Name:CAMPOS RUESGA
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 WEST 24TH AVENUE
Mailing Address - Street 2:APT 101
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3906
Mailing Address - Country:US
Mailing Address - Phone:305-299-2067
Mailing Address - Fax:
Practice Address - Street 1:6215 WEST 24TH AVENUE
Practice Address - Street 2:APT 101
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-3906
Practice Address - Country:US
Practice Address - Phone:305-299-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health