Healthcare Provider Details

I. General information

NPI: 1861558793
Provider Name (Legal Business Name): CARMEN LIZZETTE CAMACHO MA, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 WORCESTER RD
FRAMINGHAM MA
01702-5255
US

IV. Provider business mailing address

6 JASON CIR
MILFORD MA
01757-2719
US

V. Phone/Fax

Practice location:
  • Phone: 508-661-2020
  • Fax:
Mailing address:
  • Phone: 774-279-7266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180004925
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: