Provider Demographics
NPI:1992332142
Name:CAMERON, MISTY (LICSW)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:CAMERON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WASHINGTON MALL # 1313
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-2616
Mailing Address - Country:US
Mailing Address - Phone:401-219-6325
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON MALL # 1313
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-2616
Practice Address - Country:US
Practice Address - Phone:401-219-6325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1238651041C0700X
MA2245061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical