Healthcare Provider Details

I. General information

NPI: 1144351206
Provider Name (Legal Business Name): GAIL MARIE CAMPBELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GAIL MARIE GACHO DEMONTEVERDE MSW

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date: 02/18/2021
Reactivation Date: 03/25/2021

III. Provider practice location address

2855 TELEGRAPH AVE. SUITE 515
BERKELEY CA
94705
US

IV. Provider business mailing address

PO BOX 4045
TORRANCE CA
90510-4045
US

V. Phone/Fax

Practice location:
  • Phone: 888-588-8975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: