Provider Demographics
NPI:1356186811
Name:CAMACHO, MONICA SUSAN (MA, RMHCI)
Entity type:Individual
Prefix:MISS
First Name:MONICA
Middle Name:SUSAN
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:MA, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2943 OLD DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-1446
Mailing Address - Country:US
Mailing Address - Phone:407-350-2272
Mailing Address - Fax:
Practice Address - Street 1:5401 S KIRKMAN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7940
Practice Address - Country:US
Practice Address - Phone:407-917-0874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH26066101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health