Provider Demographics
NPI:1720175334
Name:CAMPOS-RODRIGUEZ, VIVIAN ALISON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:ALISON
Last Name:CAMPOS-RODRIGUEZ
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 1:3023 ALT 19 STE 102
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1930
Mailing Address - Country:US
Mailing Address - Phone:727-220-2203
Mailing Address - Fax:844-220-2203
Practice Address - Street 1:3023 ALT 19 STE 102
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1930
Practice Address - Country:US
Practice Address - Phone:727-220-2203
Practice Address - Fax:844-220-2203
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW119441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical