Provider Demographics
NPI:1558548123
Name:MORENO, CAMILLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5275 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1032
Mailing Address - Country:US
Mailing Address - Phone:510-428-3885
Mailing Address - Fax:510-601-3913
Practice Address - Street 1:5275 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1032
Practice Address - Country:US
Practice Address - Phone:510-428-3885
Practice Address - Fax:510-601-3913
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24365103TC0700X
WAPY61160459103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical