Provider Demographics
NPI:1972671089
Name:IVES, CAMERON MAXWELL (MSW,LCSW)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:MAXWELL
Last Name:IVES
Suffix:
Gender:M
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:GUS
Other - Middle Name:
Other - Last Name:IVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:PO BOX 1360
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-1360
Mailing Address - Country:US
Mailing Address - Phone:207-893-0386
Mailing Address - Fax:207-893-2086
Practice Address - Street 1:86 TANDBERG TRL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5841
Practice Address - Country:US
Practice Address - Phone:207-893-0386
Practice Address - Fax:207-893-2086
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC48661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical