Healthcare Provider Details

I. General information

NPI: 1952911125
Provider Name (Legal Business Name): BRIDGET CAMACHO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 LILY PAD LN
FLAT ROCK NC
28731-9503
US

IV. Provider business mailing address

537 TURNING LEAF LN
MILL SPRING NC
28756-4659
US

V. Phone/Fax

Practice location:
  • Phone: 167-831-4714
  • Fax:
Mailing address:
  • Phone: 678-314-4714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09926696
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC013175
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1437585882
Identifier TypeOTHER
Identifier State
Identifier IssuerAFFILIATION

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: