Provider Demographics
NPI:1609653542
Name:KAMARAS, LEAH ATHENA I
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ATHENA
Last Name:KAMARAS
Suffix:I
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 1:302 AMY WAY
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-1546
Mailing Address - Country:US
Mailing Address - Phone:609-468-1066
Mailing Address - Fax:
Practice Address - Street 1:701 CHAPEL RD
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3904
Practice Address - Country:US
Practice Address - Phone:856-381-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-297420106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician