Provider Demographics
NPI:1417099706
Name:CAMERON, PATRICIA ANN (PHD)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:CAMERON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BRIGGS COURT
Mailing Address - Street 2:
Mailing Address - City:QUEENBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804
Mailing Address - Country:US
Mailing Address - Phone:518-792-7050
Mailing Address - Fax:518-792-7050
Practice Address - Street 1:464 GLEN STREET
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-798-5884
Practice Address - Fax:518-792-7050
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0120541103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
55682BMedicare ID - Type Unspecified
000470478002Medicare UPIN