Provider Demographics
NPI:1194173278
Name:CAMEJO CRUZ, TAMARA (BCBA)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:CAMEJO CRUZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E 5TH ST UNIT 7
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-7010
Mailing Address - Country:US
Mailing Address - Phone:305-316-5846
Mailing Address - Fax:
Practice Address - Street 1:200 E 4TH ST UNIT 204
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-6223
Practice Address - Country:US
Practice Address - Phone:305-316-5846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-30
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017850200Medicaid