Provider Demographics
NPI:1720524234
Name:CAMERON, KIMBERLY C (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:C
Last Name:CAMERON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MIDDLE NECK RD # 571
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2357
Mailing Address - Country:US
Mailing Address - Phone:516-324-2281
Mailing Address - Fax:516-829-7201
Practice Address - Street 1:16 MIDDLE NECK RD # 571
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2357
Practice Address - Country:US
Practice Address - Phone:516-324-2281
Practice Address - Fax:516-829-7201
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0840421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical