Provider Demographics
NPI:1154079481
Name:TIPTON, CAMERON AMIR (BA)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:AMIR
Last Name:TIPTON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 W 63RD ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6800
Mailing Address - Country:US
Mailing Address - Phone:212-810-0290
Mailing Address - Fax:
Practice Address - Street 1:247 W 63RD ST APT 1D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6800
Practice Address - Country:US
Practice Address - Phone:212-810-0290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst