Provider Demographics
NPI:1508385568
Name:CAMACHO, ROSALIE ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:ANN
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ROSALIE
Other - Middle Name:A
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:300 RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4222
Mailing Address - Country:US
Mailing Address - Phone:401-430-2218
Mailing Address - Fax:401-453-7597
Practice Address - Street 1:300 RICHMOND ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4222
Practice Address - Country:US
Practice Address - Phone:401-430-2218
Practice Address - Fax:401-453-7597
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW018461041C0700X
RIISW029261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CSW01846OtherCLINICAL SOCIAL WORKER: LICENSE NUMBER