Provider Demographics
NPI:1407119795
Name:CAMERON, ROBERT B (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:CAMERON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WOODMOOR RD
Mailing Address - Street 2:
Mailing Address - City:S PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6553
Mailing Address - Country:US
Mailing Address - Phone:207-317-2763
Mailing Address - Fax:
Practice Address - Street 1:491 US ROUTE 1 STE 23
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-7022
Practice Address - Country:US
Practice Address - Phone:207-317-2763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC141611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical