Provider Demographics
NPI:1740685148
Name:CAMPOS, LIA MARIBEL (BA)
Entity type:Individual
Prefix:
First Name:LIA
Middle Name:MARIBEL
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 STRAWBERRY HILL AVENUE
Mailing Address - Street 2:UNIT 607
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902
Mailing Address - Country:US
Mailing Address - Phone:203-912-1448
Mailing Address - Fax:
Practice Address - Street 1:60 STRAWBERRY HILL AVENUE
Practice Address - Street 2:UNIT 607
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-912-1448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health