Provider Demographics
NPI:1659856813
Name:CAMPBELL, PATRICK (CLINICAL MSW INTERN)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:CLINICAL MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11515 SUTPHIN BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-1020
Mailing Address - Country:US
Mailing Address - Phone:718-659-4000
Mailing Address - Fax:718-659-1405
Practice Address - Street 1:11515 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1020
Practice Address - Country:US
Practice Address - Phone:718-659-4000
Practice Address - Fax:718-659-1405
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program