Provider Demographics
NPI:1265788137
Name:CAMPBELL, JESSICA SUZANNE (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SUZANNE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:SUZANNE
Other - Last Name:PAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:9905 61ST WAY S
Mailing Address - Street 2:APT C
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-2827
Mailing Address - Country:US
Mailing Address - Phone:561-289-0778
Mailing Address - Fax:
Practice Address - Street 1:1200 NW 17TH AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2503
Practice Address - Country:US
Practice Address - Phone:561-289-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW108951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical