Basic Information
Provider Information
NPI: 1790055176
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OCAMPO
FirstName: NOEL
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: LMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1065 NE 125TH ST STE 300
Address2:  
City: NORTH MIAMI
State: FL
PostalCode: 331615833
CountryCode: US
TelephoneNumber: 8888526672
FaxNumber: 3058914228
Practice Location
Address1: 1601 N PALM AVE STE 211
Address2:  
City: PEMBROKE PINES
State: FL
PostalCode: 330263204
CountryCode: US
TelephoneNumber: 9544470010
FaxNumber: 9544470899
Other Information
ProviderEnumerationDate: 01/03/2012
LastUpdateDate: 08/05/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/05/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XMH3333FLY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


Home