1528568854 NPI number — KEVIN S CAMERON, LCSW-C, LLC

Table of content: (NPI 1528568854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528568854 NPI number — KEVIN S CAMERON, LCSW-C, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEVIN S CAMERON, LCSW-C, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528568854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 EDGE KNOL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUEENSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21658-1341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-314-3400
Provider Business Mailing Address Fax Number:
410-295-0606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 FORBES ST STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-1598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-833-5980
Provider Business Practice Location Address Fax Number:
410-295-0606
Provider Enumeration Date:
02/13/2018

Additional Information

Authorized Official

Authorized Official Last Name:
CAMERON
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
515-314-3400

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  19607 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 818015MD , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com