Basic Information
| Provider Information | |||||||||
| NPI: | 1831595206 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMANO | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | RAENA | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16251 N CAVE CREEK RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850322976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808824545 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3105 E FAIRMOUNT AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850166906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028082816 | ||||||||
| FaxNumber: | 6028082716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2014 | ||||||||
| LastUpdateDate: | 05/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 20850 | AZ | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.