Provider Demographics
NPI:1629470133
Name:DE OLIVEIRA CAMPOS, JULIANA (PSYD)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:
Last Name:DE OLIVEIRA CAMPOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JULIANA
Other - Middle Name:
Other - Last Name:DE OLIVEIRA CAMPOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:445 BELLEVUE AVE STE 201C
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4923
Mailing Address - Country:US
Mailing Address - Phone:510-779-8266
Mailing Address - Fax:
Practice Address - Street 1:445 BELLEVUE AVE STE 201C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4923
Practice Address - Country:US
Practice Address - Phone:510-779-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31507103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical