Provider Demographics
NPI:1568789014
Name:CAMACHO, DIANA I (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:I
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 1:10-EE BOULEVARD AVE.
Mailing Address - Street 2:URB. LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-536-1618
Mailing Address - Fax:787-728-5862
Practice Address - Street 1:10-EE AVE. BOULEVARD
Practice Address - Street 2:URB. LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-536-1618
Practice Address - Fax:787-728-5862
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003196103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical