Provider Demographics
NPI:1093032690
Name:CAMPBELL, TADD LEON (PHD)
Entity Type:Individual
Prefix:DR
First Name:TADD
Middle Name:LEON
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2954 KENNEDY BLVD STE 2
Mailing Address - Street 2:ROSSI PSYCHOLOGICAL GROUP
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3897
Mailing Address - Country:US
Mailing Address - Phone:800-257-8715
Mailing Address - Fax:
Practice Address - Street 1:2954 KENNEDY BLVD STE 2
Practice Address - Street 2:ROSSI PSYCHOLOGICAL GROUP
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3897
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00465400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical