Provider Demographics
NPI:1881723203
Name:CAMERON, PAMELA (MA, MFTI)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:CAMERON
Suffix:
Gender:F
Credentials:MA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 SAN VICENTE BLVD APT 24
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-1537
Mailing Address - Country:US
Mailing Address - Phone:310-741-1157
Mailing Address - Fax:
Practice Address - Street 1:154 SAN VICENTE BLVD APT 24
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90402-1537
Practice Address - Country:US
Practice Address - Phone:310-741-1157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT104264101YM0800X
101YM0800X
CA104264106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC017081OtherDMH PROVIDER #