Provider Demographics
NPI:1457726747
Name:DUVALL, CAMERON
Entity Type:Individual
Prefix:MS
First Name:CAMERON
Middle Name:
Last Name:DUVALL
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 1:20 N SAN PEDRO RD
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4188
Mailing Address - Country:US
Mailing Address - Phone:415-473-7846
Mailing Address - Fax:
Practice Address - Street 1:20 N SAN PEDRO RD
Practice Address - Street 2:#2022
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4188
Practice Address - Country:US
Practice Address - Phone:415-473-7846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT93542106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist