Provider Demographics
NPI:1912711680
Name:CAMACHO, EVELYN ENID
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:ENID
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 6 K-35 URB. BONNEVILLE GARDENS
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-5841
Mailing Address - Country:US
Mailing Address - Phone:787-586-3846
Mailing Address - Fax:
Practice Address - Street 1:60 CALLE AIBONITO LOCAL #2
Practice Address - Street 2:URB. BONNEVILLE HEIGHTS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:939-395-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8116103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool