| Doctor Name: | DR. MAMIE CAMPBELL BALAJADIA |
| NPI Number: | 1427244045 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | CP003 |
| Business Practice Address: | 520 West Santa Monica Drive Dededo, GU - 96912 |
| Business Phone Number: | 6716357492 |
| Business Fax Number: | 6716357493 |
| Mailing Address: | 520 West Santa Monica Drive, DEDEDO |
| State: | GU |
| Postal Code: | 96912 |
| Phone Number: | 6716357492 |
| Fax Number: | 6716357493 |
| NPI Enumeration Date: | 09/18/2007 |
| NPI Last Update Date: | 09/18/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | CP003 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GU |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |