Provider Demographics
NPI:1144351206
Name:CAMPBELL, GAIL MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:GAIL MARIE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GAIL MARIE
Other - Middle Name:GACHO
Other - Last Name:DEMONTEVERDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 4045
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-4045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2855 TELEGRAPH AVE. SUITE 515
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705
Practice Address - Country:US
Practice Address - Phone:888-588-8975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2025-03-05
Deactivation Date:2021-02-18
Deactivation Code:
Reactivation Date:2021-03-25
Provider Licenses
StateLicense IDTaxonomies
CA247321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical