Provider Demographics
NPI:1558956128
Name:CAMPOS, JULISSA (LMSW)
Entity Type:Individual
Prefix:
First Name:JULISSA
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JULISSA
Other - Middle Name:
Other - Last Name:ESCOLASTICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 STEWART AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6611
Mailing Address - Country:US
Mailing Address - Phone:516-396-0187
Mailing Address - Fax:516-546-4114
Practice Address - Street 1:135 MAIN ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-2414
Practice Address - Country:US
Practice Address - Phone:516-572-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109017-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker