Provider Demographics
NPI:1194078683
Name:KAMARA, JUDITH WATERMAN (BSNRN, CLC, LCSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:WATERMAN
Last Name:KAMARA
Suffix:
Gender:F
Credentials:BSNRN, CLC, LCSW
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:WATERMAN
Other - Last Name:KAMARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSNRN, CLC, LCSW
Mailing Address - Street 1:PO BOX 1881
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-1881
Mailing Address - Country:US
Mailing Address - Phone:907-630-0639
Mailing Address - Fax:
Practice Address - Street 1:1044 E END RD BLDG SUITEC
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7253
Practice Address - Country:US
Practice Address - Phone:076-300-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-21
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2216201041C0700X
MARN254692163WL0100X
AK193503163WL0100X
AK1983211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty