Provider Demographics
NPI:1093285819
Name:CAMPOPIANO, JOHN MATTHEW (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MATTHEW
Last Name:CAMPOPIANO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DI PONTE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-2202
Mailing Address - Country:US
Mailing Address - Phone:401-345-1650
Mailing Address - Fax:
Practice Address - Street 1:1395 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-4929
Practice Address - Country:US
Practice Address - Phone:401-345-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW022281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical