Provider Demographics
NPI:1215414701
Name:CAMARGO, ELIZEU SABINO
Entity type:Individual
Prefix:
First Name:ELIZEU
Middle Name:SABINO
Last Name:CAMARGO
Suffix:
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 1:2017 BRIDGEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-5620
Mailing Address - Country:US
Mailing Address - Phone:407-879-7728
Mailing Address - Fax:
Practice Address - Street 1:1203 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-3721
Practice Address - Country:US
Practice Address - Phone:407-593-2757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIMH17020Medicaid