Provider Demographics
NPI:1891906384
Name:CAMERON, SCOTT LANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LANE
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 1:7945 MACARTHUR BLVD STE 221
Mailing Address - Street 2:
Mailing Address - City:CABIN JOHN
Mailing Address - State:MD
Mailing Address - Zip Code:20818-1634
Mailing Address - Country:US
Mailing Address - Phone:301-233-0927
Mailing Address - Fax:301-365-3633
Practice Address - Street 1:7945 MACARTHUR BLVD STE 221
Practice Address - Street 2:
Practice Address - City:CABIN JOHN
Practice Address - State:MD
Practice Address - Zip Code:20818-1634
Practice Address - Country:US
Practice Address - Phone:301-233-0927
Practice Address - Fax:301-365-3633
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04159103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD04159OtherPSYCHOLOGIST LICENSE
MD02-0785612OtherFEDERAL TAX ID