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General NPI Number Information
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NPI Number | 1700065075
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Entity Type | Individual
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Provider Name | LYDIA M. CAMACHO-CAPO PSY. D.
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Gender | Female
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 11/02/2007
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Provider Practice Location Address
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Address Line | 65 INFANTERIA AVENUE CALLE MARGINAL LODI 603 LOCAL 3 VILLA CAPRI
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City | SAN JUAN
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State | PR
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Zip | 00924
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Country | US
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Telephone | 787-646-3467
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Fax | 787-753-2200
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Provider Business Mailing Address
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Address Line | PO BOX 175
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City | ARECIBO
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State | PR
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Zip | 00613-0175
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Country | US
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Telephone | 787-646-3767
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Fax | 787-753-2200
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2527
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License Number State | PR
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