MEDICARE: KAMERON CARMINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1538699285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMERON CARMINA

Provider Business Mailing Address
First Line	:	680 AMERICAN AVE STE 302
Second Line	:
City	:	KING OF PRUSSIA
State	:	PA
Zip	:	19406-4023
Country	:	US
Telephone Number	:	610-644-6464
Fax Number	:	610-981-6078

Provider Business Practice Location Address
First Line	:	1725 OREGON PIKE STE B205
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17601-4296
Country	:	US
Telephone Number	:	610-644-6464
Fax Number	:	717-569-8602

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	06/15/2017

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Directions to “ KAMERON CARMINA ” Practice Location

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