Provider Demographics
NPI:1407575293
Name:CAMERO, BENCROSLE
Entity Type:Individual
Prefix:
First Name:BENCROSLE
Middle Name:
Last Name:CAMERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 KILAUEA AVE STE 60
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4264
Mailing Address - Country:US
Mailing Address - Phone:808-687-0117
Mailing Address - Fax:
Practice Address - Street 1:1221 KILAUEA AVE STE 60
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4264
Practice Address - Country:US
Practice Address - Phone:808-687-0117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician