Provider Demographics
NPI:1205466406
Name:CAMACHO, CAITLYN (LPC, ACS, NCC)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:LPC, ACS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CHERRY TREE LN
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-2211
Mailing Address - Country:US
Mailing Address - Phone:201-572-2603
Mailing Address - Fax:
Practice Address - Street 1:350 SPARTA AVE STE C2A
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1123
Practice Address - Country:US
Practice Address - Phone:973-726-4533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00706700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional