NPIMap

Individual provider Active NPI

Camille Moreno, PSYD

  • Clinical Psychologist
  • Oakland, CA
National Provider Identifier
1558548123
Registry record updated Nov 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY61160459 Issued in WA
Practice address
5275 Claremont Ave
Oakland, CA 94618-1032
Phone
(510) 428-3885
Fax
(510) 601-3913
NPI assigned
Jan 25, 2008
Last updated
Nov 6, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY24365 CA
Clinical Psychologist 103TC0700X PY61160459 WA Primary

Addresses

Primary practice location

5275 Claremont Ave
Oakland, CA 94618-1032

Mailing address

5275 Claremont Ave
Oakland, CA 94618-1032
Phone (510) 428-3885

Other practice location 1

1395 Bancroft Ave
San Leandro, CA 94577-5103
Phone (510) 357-0205 ext. 180

Other practice location 2

201 NE Park Plaza Dr Ste 145
Vancouver, WA 98684-5873
Phone (360) 729-8383

Other practice location 3

400 NE Mother Joseph Pl
Vancouver, WA 98664-3200
Phone (360) 256-2000

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

State licenses

LicenseStateTypeSpecialty
PSY24365CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Cornerstone Community Development Corporation Past Accepting new patients
Cornerstone Community Development Corporation Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: cmoreno465206@direct.peacehealth.org

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636156800000",
    "number": "1558548123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5275 CLAREMONT AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946181032",
            "telephone_number": "510-428-3885",
            "fax_number": "510-601-3913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5275 CLAREMONT AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946181032",
            "telephone_number": "510-428-3885",
            "fax_number": "510-601-3913"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1395 Bancroft Ave",
            "address_purpose": "LOCATION",
            "city": "San Leandro",
            "state": "CA",
            "postal_code": "945775103",
            "country_code": "US",
            "telephone_number": "510-357-0205 x180",
            "fax_number": "510-357-0688",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 NE Park Plaza Dr Ste 145",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986845873",
            "country_code": "US",
            "telephone_number": "360-729-8383",
            "fax_number": "360-729-3534",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 NE Mother Joseph Pl",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986643200",
            "country_code": "US",
            "telephone_number": "360-256-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORENO",
        "first_name": "CAMILLE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-25",
        "last_updated": "2021-11-06",
        "certification_date": "2021-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY24365",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY61160459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.