Provider Demographics
NPI:1255706214
Name:CAMASOSA, MA BEATRIZ
Entity type:Individual
Prefix:
First Name:MA BEATRIZ
Middle Name:
Last Name:CAMASOSA
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 1:69 N IDLEWILD AVE
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-2035
Mailing Address - Country:US
Mailing Address - Phone:630-429-5209
Mailing Address - Fax:
Practice Address - Street 1:1717 RAND RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-3509
Practice Address - Country:US
Practice Address - Phone:847-376-2148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health