Healthcare Provider Details

I. General information

NPI: 1366691362
Provider Name (Legal Business Name): REGINA ELIZA CAMACHO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REGINA ELIZA ACOSTA MSW

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 PARKMOOR AVE
SAN JOSE CA
95128-2407
US

IV. Provider business mailing address

80 GREAT OAKS BLVD B-502
SAN JOSE CA
95119
US

V. Phone/Fax

Practice location:
  • Phone: 408-282-0402
  • Fax: 408-282-0400
Mailing address:
  • Phone: 408-363-3000
  • Fax: 408-363-3046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW68521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: