Healthcare Provider Details

I. General information

NPI: 1740508266
Provider Name (Legal Business Name): BARBARA RUTH CAMPBELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 66TH AVE
OAKLAND CA
94621-3506
US

IV. Provider business mailing address

PO BOX 22210
OAKLAND CA
94623-2210
US

V. Phone/Fax

Practice location:
  • Phone: 510-639-1981
  • Fax: 510-535-4225
Mailing address:
  • Phone: 510-535-6448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS25722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: