Provider Demographics
NPI:1154567576
Name:MITTELMAN, CAMERON GREGORY
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:GREGORY
Last Name:MITTELMAN
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 1:10651 LOMOND DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-2808
Mailing Address - Country:US
Mailing Address - Phone:703-369-2976
Mailing Address - Fax:703-366-2777
Practice Address - Street 1:10651 LOMOND DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2808
Practice Address - Country:US
Practice Address - Phone:703-369-2976
Practice Address - Fax:703-366-2777
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor