Provider Demographics
NPI:1255074415
Name:WARD, CAMERON (LMSW)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:WARD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-8700
Mailing Address - Country:US
Mailing Address - Phone:802-274-0824
Mailing Address - Fax:
Practice Address - Street 1:907 ELM ST
Practice Address - Street 2:
Practice Address - City:DERBY LINE
Practice Address - State:VT
Practice Address - Zip Code:05830-8881
Practice Address - Country:US
Practice Address - Phone:802-274-0824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT156.01339511041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool