Active NPI
Brian Matthew Campbell, PH.D.
- Clinical Psychologist
- Lake Mary, FL
National Provider Identifier
1093863466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY0004142
- Practice address
- 405 Waymont CT
Suite 111
Lake Mary, FL 32746-3586 - Phone
- (407) 322-6868
- NPI assigned
- Jan 8, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY0004142 | FL | Primary |
Addresses
Primary practice location
405 Waymont CT
Suite 111
Lake Mary, FL 32746-3586
Mailing address
405 Waymont CT
Suite 111
Lake Mary, FL 32746-3586
Phone (407) 322-6868
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467491829 | Other | FL | NPI NEW LIFE CHRISTIAN C |
| 73535 | Other | FL | BLUE CROSS BLUE SHIELD |
| 0005337111 | Other | FL | AETNA PIN BRIAN CAMPBELL |
| 053111 | Other | FL | VALUE OPTIONS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY0004142 | FL | MD | Clinical Psychologist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinical Psychologist
- Lake Mary, FL
- NPI 1467491829
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093863466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 WAYMONT CT",
"address_2": "SUITE 111",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327463586",
"telephone_number": "407-322-6868"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 WAYMONT CT",
"address_2": "SUITE 111",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327463586",
"telephone_number": "407-322-6868"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMPBELL",
"first_name": "BRIAN",
"middle_name": "MATTHEW",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY0004142",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI NEW LIFE CHRISTIAN C",
"identifier": "1467491829",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "73535",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PIN BRIAN CAMPBELL",
"identifier": "0005337111",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "053111",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Mary, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.