Provider Demographics
NPI:1336228048
Name:CAMPAGNOLA, CHRISTINA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:CAMPAGNOLA
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 1:3000 STEVENS ST
Mailing Address - Street 2:UNIT 15
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2039
Mailing Address - Country:US
Mailing Address - Phone:516-678-1855
Mailing Address - Fax:516-442-5263
Practice Address - Street 1:3000 STEVENS ST
Practice Address - Street 2:UNIT 15
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2039
Practice Address - Country:US
Practice Address - Phone:516-678-1855
Practice Address - Fax:516-442-5263
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR022358-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5429633OtherOXFORD
NYA300035765OtherMEDICARE - PTAN
NY0004970OtherGHI / EMPIRE VALUE OPITON