Provider Demographics
NPI:1922194273
Name:CAMERON-GILSEY, PETER OLIVER (LICSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:OLIVER
Last Name:CAMERON-GILSEY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PIONEER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01966
Mailing Address - Country:US
Mailing Address - Phone:978-768-7109
Mailing Address - Fax:
Practice Address - Street 1:5 PIONEER CIRCLE
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:MA
Practice Address - Zip Code:01966
Practice Address - Country:US
Practice Address - Phone:978-768-7109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10158491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P04947Medicare ID - Type Unspecified