Provider Demographics
NPI:1578641734
Name:CAMPBELL, MICHAEL S (PHDLCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PHDLCSW
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1717 S ORANGE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2944
Practice Address - Country:US
Practice Address - Phone:407-650-7000
Practice Address - Fax:407-650-7124
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLSW4769104100000X, 1041C0700X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics