Healthcare Provider Details

I. General information

NPI: 1700212206
Provider Name (Legal Business Name): CAMILLE ANDREA LENDORMY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAMILLE ANDREA LENDODMY

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 INTERNATIONAL BLVD
OAKLAND CA
94601-2203
US

IV. Provider business mailing address

1422 HARRISON ST HOST BONITA HOUSE
OAKLAND CA
94612-3903
US

V. Phone/Fax

Practice location:
  • Phone: 510-601-0203
  • Fax:
Mailing address:
  • Phone: 510-809-1780
  • Fax: 510-893-1642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118583
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: