Provider Demographics
NPI:1609994706
Name:CAMPBELL, LYNN C (LCSW, CASAC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:C
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2657
Mailing Address - Country:US
Mailing Address - Phone:631-474-3249
Mailing Address - Fax:
Practice Address - Street 1:725 VETERANS MEMORIAL HIGHWAY
Practice Address - Street 2:NORTH COUNTY COMPLEX, BUILDING 151
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-6100
Practice Address - Country:US
Practice Address - Phone:631-853-6410
Practice Address - Fax:631-853-6413
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR051535-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical