Provider Demographics
NPI:1700065075
Name:CAMACHO-CAPO, LYDIA M (PSY D)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:M
Last Name:CAMACHO-CAPO
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0175
Mailing Address - Country:US
Mailing Address - Phone:787-646-3767
Mailing Address - Fax:787-753-2200
Practice Address - Street 1:65 INFANTERIA AVENUE CALLE MARGINAL LODI 603 LOCAL 3
Practice Address - Street 2:VILLA CAPRI
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-646-3467
Practice Address - Fax:787-753-2200
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2527103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical