Provider Demographics
NPI:1659046860
Name:CAMPANELLA, SAMANTHA (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:CAMPANELLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 BINGHAM AVE REAR
Mailing Address - Street 2:
Mailing Address - City:RUMSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07760-1815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1466 HOOPER AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2892
Practice Address - Country:US
Practice Address - Phone:848-287-3882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060132001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical