Provider Demographics
NPI:1326179946
Name:CAMPAGNA, VICKY ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICKY
Middle Name:ANNE
Last Name:CAMPAGNA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 GORDON ST
Mailing Address - Street 2:4
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-2768
Mailing Address - Country:US
Mailing Address - Phone:650-368-8318
Mailing Address - Fax:650-679-9378
Practice Address - Street 1:165 ARCH ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1303
Practice Address - Country:US
Practice Address - Phone:650-368-8318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15249103T00000X, 103TF0200X
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist