Provider Demographics
NPI:1578371050
Name:CAMINO COUNSELING CENTER LLC
Entity type:Organization
Organization Name:CAMINO COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:EGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-400-4997
Mailing Address - Street 1:22 PARSONAGE ST # 143
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4732
Mailing Address - Country:US
Mailing Address - Phone:401-400-4997
Mailing Address - Fax:401-227-8112
Practice Address - Street 1:22 PARSONAGE ST # 143
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4732
Practice Address - Country:US
Practice Address - Phone:401-400-4997
Practice Address - Fax:401-227-8112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty