Provider Demographics
NPI:1114491263
Name:HIROTA-LEE, CAMINA CHIYOKO
Entity Type:Individual
Prefix:
First Name:CAMINA
Middle Name:CHIYOKO
Last Name:HIROTA-LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29626 OLD CREEK LN
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7929
Mailing Address - Country:US
Mailing Address - Phone:240-408-5112
Mailing Address - Fax:
Practice Address - Street 1:29626 OLD CREEK LN
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7929
Practice Address - Country:US
Practice Address - Phone:240-408-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist