Provider Demographics
NPI:1306242037
Name:CAMARENA, EVANGELINA (LCSW)
Entity type:Individual
Prefix:
First Name:EVANGELINA
Middle Name:
Last Name:CAMARENA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6955 FOOTHILL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2426
Mailing Address - Country:US
Mailing Address - Phone:510-567-5806
Mailing Address - Fax:
Practice Address - Street 1:6955 FOOTHILL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2426
Practice Address - Country:US
Practice Address - Phone:510-567-5806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW293461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical