Individual
MRS. DEIRDRE L CAMACHO-RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSP, LBS
Contact information
Practice address
1329 N 56TH ST, PHILADELPHIA, PA 19131-4225
(215) 251-9139
Mailing address
618 6TH ST, ATCO, NJ 08004-1113
(215) 251-9139
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
BH007172
PA
Other
Enumeration date
05/24/2014
Last updated
11/07/2024
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