Healthcare Provider Details

I. General information

NPI: 1255680260
Provider Name (Legal Business Name): JAMIE CAMPOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 ANGELES VISTA BLVD
VIEW PARK CA
90043-1648
US

IV. Provider business mailing address

2200 W CENTURY BLVD UNIT 470535
LOS ANGELES CA
90047-5673
US

V. Phone/Fax

Practice location:
  • Phone: 323-295-4555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number76053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: