Provider Demographics
NPI:1700212206
Name:LENDORMY, CAMILLE ANDREA (ACSW)
Entity Type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:ANDREA
Last Name:LENDORMY
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:ANDREA
Other - Last Name:LENDODMY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1422 HARRISON ST
Mailing Address - Street 2:HOST BONITA HOUSE
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3903
Mailing Address - Country:US
Mailing Address - Phone:510-809-1780
Mailing Address - Fax:510-893-1642
Practice Address - Street 1:3001 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2203
Practice Address - Country:US
Practice Address - Phone:510-601-0203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 171M00000X
CA904921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA90492Medicaid