Provider Demographics
NPI:1528568854
Name:KEVIN S CAMERON, LCSW-C, LLC
Entity Type:Organization
Organization Name:KEVIN S CAMERON, LCSW-C, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:515-314-3400
Mailing Address - Street 1:101 EDGE KNOL LN
Mailing Address - Street 2:
Mailing Address - City:QUEENSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21658-1341
Mailing Address - Country:US
Mailing Address - Phone:515-314-3400
Mailing Address - Fax:410-295-0606
Practice Address - Street 1:104 FORBES ST STE 205
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1598
Practice Address - Country:US
Practice Address - Phone:443-833-5980
Practice Address - Fax:410-295-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD196071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD818015MDMedicaid