Provider Demographics
NPI:1205425279
Name:CAMPOS, TASNEEM (LCSW)
Entity type:Individual
Prefix:
First Name:TASNEEM
Middle Name:
Last Name:CAMPOS
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 1:5410 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2745
Mailing Address - Country:US
Mailing Address - Phone:786-286-7010
Mailing Address - Fax:
Practice Address - Street 1:5410 RIVIERA DR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2745
Practice Address - Country:US
Practice Address - Phone:786-286-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW178941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical