Provider Demographics
NPI:1891964342
Name:CAMPBELL, BONNIE JEAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:JEAN
Last Name:CAMPBELL
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 1:1361 S RIMHURST AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5167
Mailing Address - Country:US
Mailing Address - Phone:626-862-6706
Mailing Address - Fax:
Practice Address - Street 1:11001 E. V ALLEY MALL
Practice Address - Street 2:SUITE 300
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731
Practice Address - Country:US
Practice Address - Phone:626-442-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS239421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAICAN797OtherLOS ANGELES COUNTY DMH