Provider Demographics
NPI:1548862774
Name:CAMACHO, EMILY ALEXA (MA CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:ALEXA
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 OXFORD PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3016
Mailing Address - Country:US
Mailing Address - Phone:347-534-5519
Mailing Address - Fax:
Practice Address - Street 1:445 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2638
Practice Address - Country:US
Practice Address - Phone:718-979-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist