=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538645429
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMIE L CAMERON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2018
-----------------------------------------------------
Last Update Date | 07/14/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 611 US HIGHWAY 46 W STE 100
-----------------------------------------------------
City | HASBROUCK HEIGHTS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07604-3120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-478-4162
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 CANDOUR CT
-----------------------------------------------------
City | HACKETTSTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07840-4535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-798-1905
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 44SL06388300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------