Provider Demographics
NPI:1851046023
Name:CAMPAGNA, DOMINICK (MHC-LP)
Entity Type:Individual
Prefix:MR
First Name:DOMINICK
Middle Name:
Last Name:CAMPAGNA
Suffix:
Gender:M
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 ROUTE 111 STE 202
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4358
Mailing Address - Country:US
Mailing Address - Phone:631-265-9850
Mailing Address - Fax:
Practice Address - Street 1:521 ROUTE 111 STE 202
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4358
Practice Address - Country:US
Practice Address - Phone:631-265-9850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114148101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty