Provider Demographics
NPI:1619023272
Name:CAMPBELL, HARRIET BEITSCHER (LCSW,CEDS,SAP)
Entity Type:Individual
Prefix:
First Name:HARRIET
Middle Name:BEITSCHER
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW,CEDS,SAP
Other - Prefix:
Other - First Name:HARRIET
Other - Middle Name:JAN
Other - Last Name:BEITSCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW,CEDS
Mailing Address - Street 1:3155 N 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3062
Mailing Address - Country:US
Mailing Address - Phone:954-983-5055
Mailing Address - Fax:
Practice Address - Street 1:19501 N.E. 10 AVE., STE. 305
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179
Practice Address - Country:US
Practice Address - Phone:305-653-1716
Practice Address - Fax:305-653-7040
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW37731041C0700X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6519Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER