Provider Demographics
NPI:1063706539
Name:CAMDEN, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:CAMDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 ROBERT DR
Mailing Address - Street 2:6732
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-3425
Mailing Address - Country:US
Mailing Address - Phone:781-956-1299
Mailing Address - Fax:
Practice Address - Street 1:4 OLD DIAMOND ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-3425
Practice Address - Country:US
Practice Address - Phone:617-785-4838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS317307671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical