Provider Demographics
NPI:1619568656
Name:RHONE, KAMERON SAMAJ
Entity Type:Individual
Prefix:
First Name:KAMERON
Middle Name:SAMAJ
Last Name:RHONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 ROSEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2084
Mailing Address - Country:US
Mailing Address - Phone:617-980-7076
Mailing Address - Fax:
Practice Address - Street 1:37 ROSEWOOD ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2084
Practice Address - Country:US
Practice Address - Phone:617-980-7076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA00000000Medicaid