Provider Demographics
NPI:1245370519
Name:CAMPBELL, BRUCE ALEXANDER (LMSW)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:ALEXANDER
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WEST 92ND STREET
Mailing Address - Street 2:SUITE 5K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-787-1264
Mailing Address - Fax:
Practice Address - Street 1:201 WEST 92ND STREET
Practice Address - Street 2:SUITE 5K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025
Practice Address - Country:US
Practice Address - Phone:212-787-1264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0715171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical