Provider Demographics
NPI:1194055038
Name:CAMPINI, CLAIRALICE (PHD)
Entity type:Individual
Prefix:DR
First Name:CLAIRALICE
Middle Name:
Last Name:CAMPINI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WINTHROP ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4418
Mailing Address - Country:US
Mailing Address - Phone:773-726-2125
Mailing Address - Fax:
Practice Address - Street 1:234 BROADWAY STE 2
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1947
Practice Address - Country:US
Practice Address - Phone:617-758-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-26
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007659103TC0700X
MA10519103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical