Basic Information
Provider Information | |||||||||
NPI: | 1801080569 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CAMACHO | ||||||||
FirstName: | ROSEMARIE | ||||||||
MiddleName: | BELL | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LMHC, MFT, LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 12621 | ||||||||
Address2: |   | ||||||||
City: | TAMUNING | ||||||||
State: | GU | ||||||||
PostalCode: | 969312621 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6717274213 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 590 S MARINE CORPS DRIVE | ||||||||
Address2: | 1201 FLORA PAGO LANE | ||||||||
City: | CHALAN PAGO | ||||||||
State: | GU | ||||||||
PostalCode: | 96910 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6716492081 | ||||||||
FaxNumber: | 6716492083 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/05/2007 | ||||||||
LastUpdateDate: | 02/11/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/01/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 89 | GU | Y |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   |
No ID Information.