Active NPI
Camille Joan Mosso Cornell, PH.D.
- Clinical Psychologist
- Bellingham, WA
National Provider Identifier
1295238616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY60736940
- Practice address
- 103 E Holly St Ste 401
Bellingham, WA 98225-4728 - Phone
- (360) 929-4250
- NPI assigned
- Mar 12, 2018
- Last updated
- Jan 31, 2023
- Sex
- Female
- 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 | PY60736940 | WA | Primary |
Addresses
Primary practice location
103 E Holly St Ste 401
Bellingham, WA 98225-4728
Mailing address
103 E Holly St Ste 401
Bellingham, WA 98225-4728
Phone (360) 929-4250
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 21, 2020 through Jan 21, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY60736940 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675123200000",
"number": "1295238616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 E HOLLY ST STE 401",
"city": "BELLINGHAM",
"state": "WA",
"postal_code": "982254728",
"telephone_number": "360-929-4250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 E HOLLY ST STE 401",
"city": "BELLINGHAM",
"state": "WA",
"postal_code": "982254728",
"telephone_number": "360-929-4250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNELL",
"first_name": "CAMILLE",
"middle_name": "JOAN MOSSO",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-03-12",
"last_updated": "2023-01-31",
"certification_date": "2023-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY60736940",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellingham, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.