MEDICARE: MR. RENE ENRIQUE CAMACHO- CORDOBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	MH16257	FL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	16892	NY
3	101YM0800X	Mental Health Counselor	004022	NY
4	101YM0800X	Mental Health Counselor	MH16257	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962740027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RENE ENRIQUE CAMACHO- CORDOBA

Provider Business Mailing Address
First Line	:	8000 N FEDERAL HWY STE 4010
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-1680
Country	:	US
Telephone Number	:	954-605-2851
Fax Number	:	516-849-7454

Provider Business Practice Location Address
First Line	:	8000 N FEDERAL HWY STE 4010
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-1680
Country	:	US
Telephone Number	:	954-605-2851
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2013
Last Update Date	:	03/20/2026

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Directions to “ MR. RENE ENRIQUE CAMACHO- CORDOBA ” Practice Location

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