Healthcare Provider Details

I. General information

NPI: 1063706539
Provider Name (Legal Business Name): PETER CAMDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 OLD DIAMOND ST
WALPOLE MA
02081-3425
US

IV. Provider business mailing address

67 ROBERT DR 6732
SOUTH EASTON MA
02375-3425
US

V. Phone/Fax

Practice location:
  • Phone: 617-785-4838
  • Fax:
Mailing address:
  • Phone: 781-956-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119590
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: