1972889327 NPI number — MR. DOMINICK PETER CAMBER LICSW

Table of content: MR. DOMINICK PETER CAMBER LICSW (NPI 1972889327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972889327 NPI number — MR. DOMINICK PETER CAMBER LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMBER
Provider First Name:
DOMINICK
Provider Middle Name:
PETER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAMPBELL
Provider Other First Name:
DOMINICK
Provider Other Middle Name:
PETER
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972889327
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8401 5TH AVE NE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98115-4180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-659-6004
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8401 5TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115-4180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-659-6004
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LW60521607 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com