Healthcare Provider Details

I. General information

NPI: 1285544247
Provider Name (Legal Business Name): CAMERON JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VARY WAY
BERKLEY MA
02779-1720
US

IV. Provider business mailing address

23 CANONCHET AVE
WARWICK RI
02888-2957
US

V. Phone/Fax

Practice location:
  • Phone: 508-413-7366
  • Fax:
Mailing address:
  • Phone: 508-413-7366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: