Provider Demographics
NPI:1750301909
Name:CAMERON, MICHAEL E (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:CAMERON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 WESTWOOD BLVD STE 226
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2925
Mailing Address - Country:US
Mailing Address - Phone:310-208-3909
Mailing Address - Fax:
Practice Address - Street 1:1081 WESTWOOD BLVD STE 226
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-2925
Practice Address - Country:US
Practice Address - Phone:310-208-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13418103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY134180Medicaid
CAPSY134180Medicaid