Healthcare Provider Details

I. General information

NPI: 1467042630
Provider Name (Legal Business Name): KAREN H CAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 BURNETT ST
PROVIDENCE RI
02907-2527
US

IV. Provider business mailing address

275 KINGS FACTORY RD
CHARLESTOWN RI
02813-3006
US

V. Phone/Fax

Practice location:
  • Phone: 401-785-0500
  • Fax:
Mailing address:
  • Phone: 401-742-0378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP00824
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01304
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: