Provider Demographics
NPI:1538668710
Name:CAMPOLI, JENNIFER MARIA (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIA
Last Name:CAMPOLI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 FELTERS RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-2600
Mailing Address - Country:US
Mailing Address - Phone:607-201-1200
Mailing Address - Fax:
Practice Address - Street 1:35 FELTERS RD
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-2600
Practice Address - Country:US
Practice Address - Phone:607-201-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10185104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker