Provider Demographics
NPI:1790860724
Name:CAMPOS, JENNIFER LEE (LCSW, MPA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEE
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:LCSW, MPA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1373 CENTER COURT DR
Mailing Address - Street 2:ROOM 117
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3663
Mailing Address - Country:US
Mailing Address - Phone:626-859-2336
Mailing Address - Fax:626-859-3758
Practice Address - Street 1:1373 CENTER COURT DR
Practice Address - Street 2:ROOM 117
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3663
Practice Address - Country:US
Practice Address - Phone:626-859-2336
Practice Address - Fax:626-859-3758
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA628951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical