Provider Demographics
NPI:1780057786
Name:CAMINO, ANDER
Entity type:Individual
Prefix:
First Name:ANDER
Middle Name:
Last Name:CAMINO
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 1:318 OLD TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12748-5128
Mailing Address - Country:US
Mailing Address - Phone:347-638-9568
Mailing Address - Fax:
Practice Address - Street 1:318 OLD TAYLOR RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12748-5128
Practice Address - Country:US
Practice Address - Phone:347-638-9568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP96104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health