Healthcare Provider Details

I. General information

NPI: 1093855678
Provider Name (Legal Business Name): CHERYL ANN CAMARILLO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 E RAMSEY RD STE 210
SAN ANTONIO TX
78216-4667
US

IV. Provider business mailing address

404 E RAMSEY RD STE 210
SAN ANTONIO TX
78216-4667
US

V. Phone/Fax

Practice location:
  • Phone: 210-494-1991
  • Fax: 210-494-7575
Mailing address:
  • Phone: 210-494-1991
  • Fax: 210-494-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26056
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: