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NPI Code Detail

MEDICARE: MARY CAMPBELL PPS

MEDICARE: MARY CAMPBELL PPS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool Psychologist220036892CA

General Provider Information

NPI Number : 1396691036
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY CAMPBELL PPS
Provider Business Mailing Address
First Line : 1108 BISSELL AVE
Second Line :
City : RICHMOND
State : CA
Zip : 94801-3135
Country : US
Telephone Number : 510-307-4506
Fax Number :
Provider Business Practice Location Address
First Line : 7140 GLADYS AVE
Second Line :
City : EL CERRITO
State : CA
Zip : 94530-2218
Country : US
Telephone Number : 510-307-4506
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2026
Last Update Date : 03/05/2026

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