Healthcare Provider Details

I. General information

NPI: 1447714928
Provider Name (Legal Business Name): JULIE ANN MOLL CAMACHO M.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 CALLE M PEREZ FREYTES
ARECIBO PR
00612-4646
US

IV. Provider business mailing address

PARCELAS EL MANI CALLE JUAN RODRIGUEZ #364 APARTAMENTO #2
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 787-904-6949
  • Fax:
Mailing address:
  • Phone: 787-904-6949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number6243
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6243
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: