Healthcare Provider Details

I. General information

NPI: 1194078683
Provider Name (Legal Business Name): JUDITH WATERMAN KAMARA BSNRN, CLC, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDITH WATERMAN KAMARA BSNRN, CLC, LCSW

II. Dates (important events)

Enumeration Date: 10/21/2012
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 E END RD BLDG SUITEC
HOMER AK
99603-7253
US

IV. Provider business mailing address

PO BOX 1881
HOMER AK
99603-1881
US

V. Phone/Fax

Practice location:
  • Phone: 907-630-0639
  • Fax: 190-763-0063
Mailing address:
  • Phone: 907-630-0639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number221620
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN254692
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number193503
License Number StateAK
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number198321
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: