Provider Demographics
NPI:1063130714
Name:CAMPBELL, EMILY J (PHD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 MARKET ST STE 22920
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1612
Mailing Address - Country:US
Mailing Address - Phone:949-414-4416
Mailing Address - Fax:
Practice Address - Street 1:2261 MARKET ST STE 22920
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1612
Practice Address - Country:US
Practice Address - Phone:949-414-4416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CA35124103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist