Provider Demographics
NPI:1174037998
Name:MENDES, KAMERON (LMHC)
Entity Type:Individual
Prefix:
First Name:KAMERON
Middle Name:
Last Name:MENDES
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 HOWARD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-4317
Mailing Address - Country:US
Mailing Address - Phone:508-493-0738
Mailing Address - Fax:
Practice Address - Street 1:60 HOPE AVE APT 121
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2749
Practice Address - Country:US
Practice Address - Phone:781-693-9969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health