Healthcare Provider Details

I. General information

NPI: 1215798772
Provider Name (Legal Business Name): WANDA CAMACHO-MARON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 RESERVOIR ST STE 21
NEEDHAM MA
02494-3133
US

IV. Provider business mailing address

220 RESERVOIR ST STE 21
NEEDHAM MA
02494-3133
US

V. Phone/Fax

Practice location:
  • Phone: 781-429-7755
  • Fax: 781-449-2075
Mailing address:
  • Phone: 781-429-7755
  • Fax: 781-449-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: