Provider Demographics
NPI:1205946530
Name:ST. ONGE, CAMILLE G II (LICSW)
Entity type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:G
Last Name:ST. ONGE
Suffix:II
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:CAMILLE
Other - Middle Name:G
Other - Last Name:SUPKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:316 WENDELL RD
Mailing Address - Street 2:
Mailing Address - City:MILLERS FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01349-1315
Mailing Address - Country:US
Mailing Address - Phone:413-768-8013
Mailing Address - Fax:
Practice Address - Street 1:316 WENDELL RD
Practice Address - Street 2:
Practice Address - City:MILLERS FALLS
Practice Address - State:MA
Practice Address - Zip Code:01349-1315
Practice Address - Country:US
Practice Address - Phone:413-768-8013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1023144104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP21122Medicare ID - Type Unspecified