Provider Demographics
NPI:1336739366
Name:QUINTERO, CAMILA REGINA (LCSW)
Entity Type:Individual
Prefix:
First Name:CAMILA
Middle Name:REGINA
Last Name:QUINTERO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 SW 12TH ST APT 1702
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-5204
Mailing Address - Country:US
Mailing Address - Phone:310-795-2528
Mailing Address - Fax:
Practice Address - Street 1:79 SW 12TH ST APT 1702
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-5204
Practice Address - Country:US
Practice Address - Phone:310-795-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW178351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty