Provider Demographics
NPI:1972280055
Name:CAMACHO, MARIA C (LCSW)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:CAMACHO
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 1:717 S CLARK ST UNIT 1007
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1797
Mailing Address - Country:US
Mailing Address - Phone:281-691-3745
Mailing Address - Fax:
Practice Address - Street 1:717 S CLARK ST UNIT 1007
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1797
Practice Address - Country:US
Practice Address - Phone:281-691-3745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0235971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical