Provider Demographics
NPI:1972139798
Name:BAEZ RAMOS, CAMILLE ROCIO (PSYD)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:ROCIO
Last Name:BAEZ RAMOS
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:HC 5 BOX 5399
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-9672
Mailing Address - Country:US
Mailing Address - Phone:787-517-3353
Mailing Address - Fax:
Practice Address - Street 1:355 CALLE FONT MARTELO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3249
Practice Address - Country:US
Practice Address - Phone:787-517-3353
Practice Address - Fax:787-561-7464
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6323103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty