Provider Demographics
NPI:1457022717
Name:CAMACHO, CARA (LMHC)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ODELL CLARK PL APT 4F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-2322
Mailing Address - Country:US
Mailing Address - Phone:347-291-4278
Mailing Address - Fax:
Practice Address - Street 1:120 ODELL CLARK PL APT 4F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-2322
Practice Address - Country:US
Practice Address - Phone:347-291-4278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011554101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health