Provider Demographics
NPI:1750786463
Name:CAMEJO, JORGE LUIS II
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:LUIS
Last Name:CAMEJO
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 JAY PL
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-1009
Mailing Address - Country:US
Mailing Address - Phone:203-500-8856
Mailing Address - Fax:
Practice Address - Street 1:17 JAY PL
Practice Address - Street 2:
Practice Address - City:NORTH BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06471-1009
Practice Address - Country:US
Practice Address - Phone:203-500-8856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health