Provider Demographics
NPI:1427660620
Name:CAMILO, NICAURIS
Entity type:Individual
Prefix:
First Name:NICAURIS
Middle Name:
Last Name:CAMILO
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 1:307 MONROE ST STE 4-7
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5207
Mailing Address - Country:US
Mailing Address - Phone:862-238-7550
Mailing Address - Fax:
Practice Address - Street 1:307 MONROE ST STE 4-7
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5207
Practice Address - Country:US
Practice Address - Phone:862-238-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty