Provider Demographics
NPI:1407529936
Name:TIBERGHIEN, CAMILLE JENSEN
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:JENSEN
Last Name:TIBERGHIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2156 VIA CAMINO VERDE APT 2
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-7363
Mailing Address - Country:US
Mailing Address - Phone:714-586-6631
Mailing Address - Fax:
Practice Address - Street 1:2610 ACUNA CT
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-6401
Practice Address - Country:US
Practice Address - Phone:916-744-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical