Provider Demographics
NPI:1124397195
Name:CAMPBELL, JOANN CAVO (LCSW)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:CAVO
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 WHITESBORO ST
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13495-1313
Mailing Address - Country:US
Mailing Address - Phone:315-266-3190
Mailing Address - Fax:
Practice Address - Street 1:67 WHITESBORO ST
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:NY
Practice Address - Zip Code:13495-1313
Practice Address - Country:US
Practice Address - Phone:315-266-3190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0205571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical