Provider Demographics
NPI:1871116012
Name:CAMPBELL, RAQUEL Y (PHD)
Entity type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:Y
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 TOSCANA PL APT 309
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-8071
Mailing Address - Country:US
Mailing Address - Phone:954-213-4790
Mailing Address - Fax:
Practice Address - Street 1:5925 TOSCANA PL APT 309
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-8071
Practice Address - Country:US
Practice Address - Phone:954-213-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3550106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist