Healthcare Provider Details

I. General information

NPI: 1487566451
Provider Name (Legal Business Name): KAMERYN MAIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 W MAIN ST # A-5
FREEHOLD NJ
07728-2140
US

IV. Provider business mailing address

340 CHANGEBRIDGE RD APT 464
PINE BROOK NJ
07058-4414
US

V. Phone/Fax

Practice location:
  • Phone: 848-300-3933
  • Fax:
Mailing address:
  • Phone: 973-650-0413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC01005400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: