Provider Demographics
NPI:1649813213
Name:RODRIGUEZ CAMACHO, YOMAR JAVIER (MSW)
Entity type:Individual
Prefix:
First Name:YOMAR
Middle Name:JAVIER
Last Name:RODRIGUEZ CAMACHO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CALLE VICITACION CENTENO
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-3546
Mailing Address - Country:US
Mailing Address - Phone:787-405-8407
Mailing Address - Fax:
Practice Address - Street 1:CALLE SGTO GERARDO SANTIAGO
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-714-2462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR244731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical