Provider Demographics
NPI:1578835526
Name:CAMERON, CHRISTINA MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:KEENAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-4354
Mailing Address - Country:US
Mailing Address - Phone:860-210-1795
Mailing Address - Fax:860-797-2431
Practice Address - Street 1:221 DANBURY RD
Practice Address - Street 2:SUITE G
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-4354
Practice Address - Country:US
Practice Address - Phone:860-210-1795
Practice Address - Fax:860-797-2431
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1198101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004123840Medicaid
CT008017939Medicaid
CT008039669Medicaid
CT008031626Medicaid