Provider Demographics
NPI:1528610045
Name:PALACIOS CAMACHO, CARMEN (LMHC, NCC)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:PALACIOS CAMACHO
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 NW 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2005
Mailing Address - Country:US
Mailing Address - Phone:754-273-0581
Mailing Address - Fax:
Practice Address - Street 1:515 NW 49TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2005
Practice Address - Country:US
Practice Address - Phone:754-273-0581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16970101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health