Provider Demographics
NPI:1417141276
Name:CAMPBELL, EDWIN F (PHD)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:F
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 1:240 W 102ND ST
Mailing Address - Street 2:SUITE 22
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-4900
Mailing Address - Country:US
Mailing Address - Phone:212-865-8567
Mailing Address - Fax:
Practice Address - Street 1:240 W 102ND ST
Practice Address - Street 2:SUITE 22
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-4900
Practice Address - Country:US
Practice Address - Phone:212-865-8567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY5906103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV57361Medicare PIN