Provider Demographics
NPI:1962868208
Name:CAMILLE-KERMEUS, LUCIMENE
Entity type:Individual
Prefix:
First Name:LUCIMENE
Middle Name:
Last Name:CAMILLE-KERMEUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 WATERTOWN STREET
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-5119
Mailing Address - Country:US
Mailing Address - Phone:617-272-0212
Mailing Address - Fax:
Practice Address - Street 1:139 WATERTOWN STREET
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-5119
Practice Address - Country:US
Practice Address - Phone:617-272-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst