Healthcare Provider Details

I. General information

NPI: 1922522044
Provider Name (Legal Business Name): VALERIA CAMPOS MSW, ASW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 E BONITA AVE
POMONA CA
91767-1906
US

IV. Provider business mailing address

479 RICHLAND ST APT K
UPLAND CA
91786-6710
US

V. Phone/Fax

Practice location:
  • Phone: 909-625-7207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW109198
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number77780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: