Provider Demographics
NPI:1467224386
Name:CAMPBELL, JESSICA V
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:V
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12032 168TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-2523
Mailing Address - Country:US
Mailing Address - Phone:347-650-7720
Mailing Address - Fax:
Practice Address - Street 1:12032 168TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-2523
Practice Address - Country:US
Practice Address - Phone:347-650-7720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker