Provider Demographics
NPI:1053625095
Name:CAMPBELL, DEBORAH G (LMHC, CASAC)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:G
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMHC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 LIVINGSTON ST APT 20C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5053
Mailing Address - Country:US
Mailing Address - Phone:917-453-6882
Mailing Address - Fax:
Practice Address - Street 1:119 WASHINGTON PL
Practice Address - Street 2:SUITE C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3837
Practice Address - Country:US
Practice Address - Phone:917-453-6882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7267101YA0400X
NY002034101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)