Provider Demographics
NPI:1649004151
Name:CAMP, GONZALO JOSE (LCSW)
Entity type:Individual
Prefix:
First Name:GONZALO
Middle Name:JOSE
Last Name:CAMP
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 FIR ACRES DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1884
Mailing Address - Country:US
Mailing Address - Phone:479-301-9879
Mailing Address - Fax:
Practice Address - Street 1:1185 FIR ACRES DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-1884
Practice Address - Country:US
Practice Address - Phone:479-301-9879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL141451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical