Provider Demographics
NPI:1124808902
Name:CAMACHO, VICTORIA ALTAGRACIA (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ALTAGRACIA
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 7TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-4023
Mailing Address - Country:US
Mailing Address - Phone:646-284-7876
Mailing Address - Fax:646-284-7876
Practice Address - Street 1:107 W 82ND ST # P101
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5511
Practice Address - Country:US
Practice Address - Phone:646-389-4112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2-21-56351103K00000X
CO1-21-56351103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty