Healthcare Provider Details

I. General information

NPI: 1598045429
Provider Name (Legal Business Name): MRS. CAMERON HOLLIDAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAMERON BROWN MSW

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 EUCLID ST
SANTA MONICA CA
90404-3306
US

IV. Provider business mailing address

1533 EUCLID ST
SANTA MONICA CA
90404-3306
US

V. Phone/Fax

Practice location:
  • Phone: 310-451-9747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number31145
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 63999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: