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NPI Code Detail

MEDICARE: JORGE CAMARENA B.S.

MEDICARE: JORGE CAMARENA B.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2202591OTHERILMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11617631OTHERILBLUE CROSS BLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760609143
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORGE CAMARENA B.S.
Provider Business Mailing Address
First Line : 2803 S TRUMBULL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60623-4653
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5341 W CERMAK RD
Second Line :
City : CICERO
State : IL
Zip : 60804-2817
Country : US
Telephone Number : 708-656-6430
Fax Number : 708-656-6591
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2007
Last Update Date : 09/17/2008

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Directions to “ JORGE CAMARENA B.S.” Practice Location

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