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General NPI Number Information
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NPI Number | 1871034025
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Entity Type | Organization
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Legal Business Name | BRENDA GONZALEZ CAMACHO LCSW
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 22099 ELMIRA BLVD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-7018
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Country | US
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Telephone | 941-613-1356
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Fax | 941-613-1591
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Provider Business Mailing Address
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Address Line | 22099 ELMIRA BLVD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-7018
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Country | US
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Telephone | 941-613-1356
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Fax | 941-613-1591
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRENDA GONZALEZ CAMACHO
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Credential | LCSW
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Telephone | 941-613-1356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW8837
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License Number State | FL
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