Provider Demographics
NPI:1427131119
Name:KYLE, CAMERON (LICSW)
Entity type:Individual
Prefix:MS
First Name:CAMERON
Middle Name:
Last Name:KYLE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SUMMER STREET
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464
Mailing Address - Country:US
Mailing Address - Phone:617-527-3903
Mailing Address - Fax:
Practice Address - Street 1:543 NORTH STREET
Practice Address - Street 2:C/O CHILD & FAMILY SERVICES
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:508-984-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10197461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P20104OtherBCBS
P20104Medicare ID - Type Unspecified