Provider Demographics
NPI:1538133970
Name:CAMPBELL, JANET L (LCSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
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 1:22 NORTH RD., PO BOX 166
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12721
Mailing Address - Country:US
Mailing Address - Phone:845-733-6759
Mailing Address - Fax:845-733-6759
Practice Address - Street 1:22 NORTH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGBURG
Practice Address - State:NY
Practice Address - Zip Code:12721-4654
Practice Address - Country:US
Practice Address - Phone:845-733-6759
Practice Address - Fax:845-733-6759
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0345961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN65031Medicare UPIN
NY506532Medicare PIN