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General NPI Number Information
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NPI Number | 1174037998
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Entity Type | Individual
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Provider Name | KAMERON MENDES LMHC
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Gender | Male
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Dates
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Enumeration Date | 12/01/2017
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Last Update Date | 12/01/2017
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Provider Practice Location Address
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Address Line | 60 HOPE AVE APT 121
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City | WALTHAM
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State | MA
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Zip | 02453-2749
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Country | US
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Telephone | 781-693-9969
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Fax |
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Provider Business Mailing Address
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Address Line | 51 HOWARD ST APT 2
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City | WALTHAM
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State | MA
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Zip | 02451-4317
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Country | US
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Telephone | 508-493-0738
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10226
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License Number State | MA
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