Provider Demographics
NPI:1194078683
Name:KAMARA, JUDITH WATERMAN (LCSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:WATERMAN
Last Name:KAMARA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:WATERMAN
Other - Last Name:KAMARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSNRN, CLC
Mailing Address - Street 1:109 OLD OAKEN BUCKET RD
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-4434
Mailing Address - Country:US
Mailing Address - Phone:781-228-0980
Mailing Address - Fax:
Practice Address - Street 1:109 OLD OAKEN BUCKET RD
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4434
Practice Address - Country:US
Practice Address - Phone:781-228-0980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-21
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN254692163W00000X, 163WL0100X
MA2216201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty