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Individual

MR. EUSEBIO ENRIQUE CAMACHO MEDINA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MSW, LSW MASTERS

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
150105643
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1316027998
IN
Enumeration date
09/30/2015
Last updated
01/29/2024
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