Provider Demographics
NPI:1700295458
Name:BERGERON, CAMERON (LICSW)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:BERGERON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CAMERON
Other - Middle Name:
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:77 NORTHEASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3128
Mailing Address - Country:US
Mailing Address - Phone:603-882-3616
Mailing Address - Fax:
Practice Address - Street 1:45 HIGH ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3312
Practice Address - Country:US
Practice Address - Phone:603-816-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174400000XOther Service ProvidersSpecialist