Provider Demographics
NPI:1144718610
Name:CAMACHO-GRAHAM, ROSA LIZZETTE
Entity type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:LIZZETTE
Last Name:CAMACHO-GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ROSA
Other - Middle Name:LIZZETTE
Other - Last Name:CAMACHO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:293 UPPER FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-2184
Mailing Address - Country:US
Mailing Address - Phone:585-922-0212
Mailing Address - Fax:585-922-0230
Practice Address - Street 1:293 UPPER FALLS BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-2184
Practice Address - Country:US
Practice Address - Phone:585-922-0212
Practice Address - Fax:585-922-0200
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092966-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker